Open wounds treatment is very often a challenge for both the physician and patient. They require long term complex treatment with surgical debridement, dressing changing, additional therapies including expensive medication, with a high risk of failure. The most difficult to treat are the diabetic wounds and those that are associated with advanced arterial disease. In these special cases, the peripheral vascularization is severely impaired and the complications are imminent. Sixteen patients were selected from those appearing to our hospital departments of orthopedic and plastic surgery. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base following trauma or diabetes, in which NPWT was indicated, without exclusion criteria. Patients enrolled were treated with regularly scheduled NPWT dressing change and using of a collagen scaffold. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. Both applications of these therapies appeared to accelerate the wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Some of the patients were healed partially and plastic surgery techniques were applied. Use of collagen scaffolds in conjunction with negative pressure wound therapy in the care of complex wounds is a reliable and effective method combining both the new granular tissue formation capacity of the scaffold to hold osteoblasts. In our experience, we have noticed that the patients benefit greatly when collagen scaffolds is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds in healing.

Many researchers perform different research in the area of ostheosznthesis metallic implants used in orthopedic surgery. The main goal of internal fixation is to achieve full operation until patient recovery. Although implants are intended to withstand until bone consolidation in some cases problems occur due to accelerate wear and corrosion processes. The aim of the present study was to determine the causes leading to adverse reactions of the surrounding tissues in case of three implants for osteosynthesis type plate-screw.

This study aims to present the preliminary studies related to the evaluation of the in vivo biocompatibility using the rat model of bioresorbable composite materials type collagen-tricalciumphophate and colagen-tricalcium phosphate-magnesium for potentially medical application in trauma surgery. These biomaterials could be used as short-term structural support for bone tissue defects and can be reabsorbed into the body after healing are being sought. For in-vivo evaluation of bioresorbable materials on 2 groups of twenty Wistar and brown Norway rats for a period of 18 months. We simulated tissue defects in different anatomical areas of the animals and these two types of biomaterials were implanted. The animals were evaluated periodically with clinical exams, laboratory tests (blood tests, histopatological tests, radiological control) and anatomical dissection for macroscopic examination of the tissues. After different times (3, 6 and18 months) of implantation we sacrificed the animals. We observed the resorbtion rate of the biomaterials into the tissues in conjunction with tissue regeneration. We also note the inflammatory response and foreign body reactions into the adjacent tissue, using histopathological examinations. Due to the reaction of the materials in contact with the bone narrow a layer of magnesium calcium phosphate was formed which contributes to the local tissue healing. Our preliminary investigation results on these materials demonstrate that all the implanted materials were absorbed in vivo without any pathological changes in the rat body. Other future researches will be made in order to validate these biomaterials as orthopedic biomaterials useful in bone defects regeneration.

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

Antibiotic delivery systems used in the past have consisted primarily of impregnated cement beads that required routine removal once the antibiotic had eluded completely. With the development of collagen scaffolds that could be used to fill bony defects the antibiotic cold be delivered from the scaffold used to sustain local bone growth. Over the course of two years antibiotic loaded collagen scaffolds were used in the local treatment of 21patients suffering of complicated fractures including bone defects, infections or pseudoarthrosis, all of them of traumatic nature. At the time of the initial surgical debridement or at subsequent second look procedures once local tissue viability was observed the antibiotic loaded collagen scaffold was inserted in the tissue defect and never removed. Excellent results were obtained and the infection was brought under control by use of both surgical and antibiotic modalities. Bone grafting was used in 6 cases where the defects were extensive. Where there was less extensive bone destruction the scaffold was a good adjuvant in new bone formation. Use of antibiotic loaded collagen scaffolds is a reliable and effective means of local antibiotic delivery system combining both the new bone formation capacity of the scaffold to hold osteoblasts with the ability to deliver high doses of antibiotic in the local tissue environment and thus avoiding the systemic toxicity.