scholarly journals The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis – comparative analysis of custom-made versus commercially available nails

2021 ◽  
Vol 6 (9) ◽  
pp. 457-466
Author(s):  
Germán Garabano ◽  
Hernán del Sel ◽  
Joaquin Anibal Rodriguez ◽  
Leonel Perez Alamino ◽  
Cesar Angel Pesciallo
Keyword(s):  
Comparative Analysis ◽  
Infection Control ◽  
Failure Rate ◽  
Operating Time ◽  
Consecutive Series ◽  
Antibiotic Cement ◽  
Custom Made ◽  
Initial Injury ◽  
Post Traumatic ◽  
Reoperation Rates

Abstract. Background: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement–nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results: Thirty patients were included. The affected bones were the femur (n=15) and the tibia (n=15). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement–bone debonding. Commercial nails were associated with shorter operating times (p<0.0001). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement–bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.

scholarly journals Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Guoliang Wang ◽  
Wen Luo ◽  
Yong Zhou ◽  
Zhenfeng Zhu ◽  
Zihou Zhao ◽  
...  
Keyword(s):  
Infection Control ◽  
Bone Healing ◽  
Bone Defects ◽  
Long Bone ◽  
Antibiotic Cement ◽  
Sf 36 ◽  
Custom Made ◽  
Printing Technique ◽  
3D Printing Technique

Background. Longbone infected bone defect remains a great challenge due to multiple surgeries, long-term treatment duration, and uncertain prognosis. Treatment principles include eradication/debridement, stabilization, and antibiotic administration. An antibiotic cement-coated nail has shown great prospects due to both local antibiotic elution and stabilization of bone defects. However, the current fabrication technique remains to be improved. Methods. For the first time, we described a new method for custom-made cement-coated nail fabrication based on a 3D printing technique. A retrospective study of 19 consecutive patients with long bone infected bone defects from one medical center was conducted who met the inclusion and exclusion criteria from November 2016 to May 2020. The treatment involved thorough debridement, custom-made antibiotic cement-coated nail filling, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Clinical and radiographic examinations (X-ray and CT scans) were used to evaluate bony union. Clinical and laboratory examinations were used to evaluate the infection control. The SF-36 score was used to evaluate patients’ quality of life pre- and postoperatively. Results. The mean follow-up was 98.8 weeks (ranging from 40 to 192). All cases achieved infection control, 3 cases achieved bone healing after one-stage operation, and 12 cases achieved bone healing after a two-stage bone graft procedure. At the last follow-up, none of the 19 patients had infection recurrence or 1 case had failure of the protective plate. The pre- and postoperative SF-36 score showed that there were statistical differences in all the 9 aspects. Conclusions. The precise custom-made antibiotic cement-coated intramedullary nail through the 3D printing technique used in this study is an effective strategy for the treatment of infected bone defects of long bone. This technique may help to increase the infection control rate and promote bone healing.

scholarly journals Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Marcin K. Wasko ◽  
Rafal Kaminski
Keyword(s):  
Failure Mechanisms ◽  
Medullary Canal ◽  
Bone Infection ◽  
Long Bone ◽  
Current Evidence ◽  
Orthopaedic Trauma ◽  
Antibiotic Cement ◽  
Custom Made ◽  
Trauma Surgeons ◽  
Technique Failure

Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons’ hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection.

Limb-salvage reconstruction following resection of pelvic bone sarcomas involving the acetabulum

2021 ◽  
Vol 103-B (4) ◽  
pp. 795-803
Author(s):  
Tomohiro Fujiwara ◽  
Manuel Ricardo Medellin Rincon ◽  
Andrea Sambri ◽  
Yusuke Tsuda ◽  
Rhys Clark ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Major Complication ◽  
Ice Cream ◽  
Pelvic Bone ◽  
Limb Salvage Surgery ◽  
Consecutive Series ◽  
Major Complications ◽  
Custom Made ◽  
The Mean ◽  
Custom Made Prostheses

Aims Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. Methods The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). Results The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). Conclusion Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795–803.

Reconstruction of Fingertip Amputations by Partial Composite Toe Transfer with Short Vascular Pedicle

1998 ◽  
Vol 23 (4) ◽  
pp. 457-464 ◽  
Author(s):  
G. DAUTEL ◽  
D. CORCELLA ◽  
M. MERLE
Keyword(s):  
Nail Plate ◽  
Surgical Reconstruction ◽  
Vascular Pedicle ◽  
Recipient Site ◽  
Fingertip Amputation ◽  
Custom Made ◽  
Initial Injury ◽  
Toe Transfer ◽  
Second Toe ◽  
Exact Amount

Five patients under 15 years-of-age, with a fingertip amputation through the nail plate, were treated with a custom-made partial toe transfer. Two of the patients hid had previous attempts at surgical reconstruction using either a local flap or replantation. Delay between initial injury and reconstruction ranged from 2 to 60 days. In all cases the flap was harvested from the second toe. This “custom-made” compound transfer included the exact amount of pulp, nail bed and bone required for reconstruction. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a digital level on the recipient site. Good to excellent cosmetic results were obtained in all cases, with a nearly normal-looking fingertip. Duration of hospital stay ranged from 4 to 7 days. We recommend this technique for treatment of distal amputation close to the proximal nail fold, in young individuals.

scholarly journals Neurogenesis and Oligodendrogenesis in a Mouse Model of Blast-Induced Traumatic Brain Injury

2020 ◽  
pp. 1-14
Author(s):  
Michal K. Stachowiak ◽  
D. Freedman ◽  
N. Nived ◽  
B. Decker ◽  
S. Narla ◽  
...  
Keyword(s):  
Brain Injury ◽  
Brain Function ◽  
Brain Cortex ◽  
Post Traumatic Stress ◽  
Model Following ◽  
Initial Injury ◽  
Initial Activation ◽  
Post Traumatic ◽  
Oligodendrocyte Precursor ◽  
The Brain

Neurological manifestations of blast-induced Post Traumatic Stress Disorder (PTSD) extend long after the initial injury indicating lasting changes in brain function. In this study, we characterized brain injury, changes in neurogenesis and oligodendrogenesis in an adult murine blast model following a short (5 days) and long (21 days) post-blast recovery. Acoustic blasts led to an initial, activation of microglia and astrogliosis and a widespread cortical and subcortical apoptosis. The loss of myelinated cortical axons at 5 days was followed by the reappearance of abnormal misdirected fibers at 21 days. At 21 days post-blast, we observed increases in doublecortin-positive (DCX+ ) neuroblasts in the subventricular zone (SVZ) and hippocampal subgranular zone (SGZ) indicating increased neurogenesis. No changes in DCX+ cells were found in the brain cortex. In the cortex, the early disappearance of myelinated neuronal fibers was accompanied by a loss of O4+ oligodendrocytes and their Ki67-expreasing (Ki67+ ) oligodendrocyte precursor cells (OPC). However, at 5 days we observed a robust appearance of cells expressing Olig2 (O2+ ), an early determinant of oligodendrocyte lineage. At 21 days post-blast, the population of OPC increased and the mature O4+ oligodendrocytes were restored to control levels. In contrast, in the SVZ and SGZ, O4+ cells were not affected by the blast suggesting a local cortical origin for cortical oligodendrogenesis. These results suggest that blast-induced activation of SVZ and SGZ neurogenesis and cortical oligodendrogenesis could have long-lasting impact on brain function including memory disorders observed in both animal models and human’s PTSD.

Revision Arthroplasty with Total Femur Replacement for the Management of Complex Post-traumatic Bone Defect in a Patient with Dwarfism

2020 ◽  
Author(s):  
Christian Lausmann ◽  
Stefan Niculescu ◽  
Mustafa Citak ◽  
Markus Rossmann ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Lower Limb ◽  
Early Onset ◽  
Normal Population ◽  
Revision Arthroplasty ◽  
First Case ◽  
Custom Made ◽  
Total Femoral Replacement ◽  
Post Traumatic ◽  
Valgus Gonarthrosis ◽  
Bone Deformities

AbstractDwarfism leads to an early onset of osteoarthritis of the joints of the lower limb. Due to bone deformities, arthroplasty is challenging. The incidence of implant-associated complications is higher compared to the normal population and often ends up with multiple revision arthroplasties. We report the first case in the literature of a 48-year-old patient with dwarfism who required implantation of a custom-made total femoral replacement due to aseptic stem loosening and a concomitant valgus gonarthrosis.

scholarly journals Repair of Orbital Post-Traumatic Wall Defects by Custom-Made TiNi Mesh Endografts

2019 ◽  
Vol 10 (3) ◽  
pp. 27 ◽  
Author(s):  
Valentin Shtin ◽  
Valeriy Novikov ◽  
Timofey Chekalkin ◽  
Victor Gunther ◽  
Ekaterina Marchenko ◽  
...  
Keyword(s):  
Early Period ◽  
Late Complications ◽  
Attractive Alternative ◽  
High Resolution Computed Tomography ◽  
Suggested Technique ◽  
Custom Made ◽  
Cad Modelling ◽  
Post Traumatic ◽  
High Level

Repairs of orbital post-traumatic and extensive malignant defects remain a major surgical challenge, in view of follow-up outcomes. Incorrect surgical management of injured facial structures results in cosmetic, ophthalmic, and social aftereffects. A custom-made knitted TiNi-based mesh (KTNM) endograft was employed to overcome post-surgical complications and post-resected lesions of the orbital area. Preoperative high-resolution computed tomography (CT) imaging and CAD modelling were used to design the customized KTNM in each case. Twenty-five patients underwent surgery utilizing the suggested technique, from 2014 to 2019. In all documented cases, resolution of the ophthalmic malfunction was noted in the early period. Follow-up observation evidenced no relapsed enophthalmos, hypoglobus, or diplopia as late complications. The findings emanating from our clinical observations allow us to claim that the KTNM indicated a high level of biocompatibility. It is simply modified intraoperatively to attach any desired shape/size for implantation and can also be screw-fixed, providing a good supporting ability. The KTNM precisely renders orbitozygomatic outlines and orbital floor, thus recovering the anatomical structure, and is regarded as an attractive alternative to Ti-based meshes and plates. Additionally, we report one of the studied cases, where good functional and cosmetic outcomes have been achieved.

scholarly journals Polyethylene-Based Knee Spacer for Infection Control: Design Concept and Pre-Clinical In Vitro Validations

Polymers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2334
Author(s):  
Yuhan Chang ◽  
Mel S. Lee ◽  
Jiann-Jong Liau ◽  
Yu-Liang Liu ◽  
Wen-Chuan Chen ◽  
...  
Keyword(s):  
Infection Control ◽  
Fatigue Testing ◽  
The Novel ◽  
Volumetric Wear ◽  
Antibiotic Cement ◽  
Joint Infections ◽  
Structural Fracture ◽  
Articulating Surface ◽  
Validation Tests

Antibiotic-loaded polymethyl methacrylate (PMMA) has been widely applied in the treatment of knee periprosthetic joint infections. However, problems with antibiotic-loaded PMMA-based spacers, such as structural fracture and implant dislocation, remain unresolved. A novel polyethylene-based spacer, designed with an ultra-congruent articulating surface and multiple fenestrations, was introduced in the current study. Validation tests for biomechanical safety, wear performance, and efficacy of antibiotic cement were reported. During cycle fatigue testing, no tibial spacer failures were observed, and less wear debris generation was reported compared to commercial PMMA-based spacers. The volumetric wear of the novel spacer was within the safety threshold for osteolysis-free volumetric wear. An effective infection control was demonstrated despite the application of lesser antibiotic cement in the 30-day antibiotic elution test. The tube dilution test confirmed adequate inhibitory capabilities against pathogens with the loaded antibiotic option utilized in the current study. The novel polyethylene-based knee spacer may offer sufficient biomechanical safety and serve as an adequate carrier of antibiotic-loaded cement for infection control. Further clinical trials shall be conducted for more comprehensive validation of the novel spacer for practical application.

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