Dead Space Management After Orthopaedic Trauma

Gage, Mark J.; Yoon, Richard S.; Gaines, Robert J.; Dunbar, Robert P; Egol, Kenneth A.; Liporace, Frank A.

doi:10.1097/bot.0000000000000454

Cited by 18 publications

(19 citation statements)

References 76 publications

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“…Following infection eradication, osseous repair of the cavity is critical following debridement. Patients with residual dead space are at high risk for subsequent infection or reinfection [1] therefore in the setting of active infection, methods which support the local release of antibiotics are preferable.…”

Section: Introductionmentioning

confidence: 99%

Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model

Oliver

Lovric

Christou

et al. 2020

J Mater Sci: Mater Med

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The study aimed to evaluate the comparative osteoconductivity of three commercially available bone void fillers containing gentamicin with respect to new bone, growth, host tissue response and resorption of the implant material. Defects were created in the cancellous bone of the distal femur and proximal tibia of 12-skeletally mature sheep and filled with three commercially available bone void fillers containing gentamicin (Stimulan-G, Cerament-G, Herafill-G). Peripheral blood was taken pre-operatively and at the time of implantation, as well as at intermittent timepoints following surgery to determine systemic gentamicin levels (5-,15- and 30- minutes, 1, 2, 3, 6, 12, 24, 48- and 72-hours, 3-, 6- and 12-weeks). Decalcified, embedded samples were stained with haematoxylin and eosin (H&E) and used to assess the host tissue response and the formation of new bone in the presence of test implant materials. No adverse reactions were noted at harvest at any time points for any cancellous implantation sites with the various implant materials. Comparative microCT analysis of the Stimulan-G, Cerament-G and Herafill-G test materials revealed a similar increase in bone surface area and volume between animals implanted with Stimulan-G or Cerament-G test materials. Animals implanted with Herafill-G test materials demonstrated the lowest increases in bone volume and surface area of the test materials tested, at levels similar to the negative control sites. By 12-weeks, Stimulan-G defects were completely closed with mature bone and bone marrow whilst the Cerament-G material was still present after 12 weeks by histological examination. In conclusion, this study demonstrated differences in the bone regenerative capacity of a range of bone void fillers in an in vivo setting.

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Section: Introductionmentioning

confidence: 99%

Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model

Oliver

Lovric

Christou

et al. 2020

J Mater Sci: Mater Med

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“…As a type of bone defect challenging to heal, IBD is mainly caused by trauma, deformity, infection, and other factors, which have a high disability and deformity rate, prolonged healing time, and complex healing process, and occupy a lot of medical resources. 48 Moreover, its treatment requires both the healing of bone defects and the killing of infectious bacteria to maintain the sterile environment of the bone defect. 49 , 50 Therefore, IBD is a common issue faced by many disciplines, such as orthopedics clinics, medical materials science, and tissue engineering.…”

Section: Discussionmentioning

confidence: 99%

The Antibacterial Effect, Biocompatibility, and Osteogenesis of Vancomycin-Nanodiamond Composite Scaffold for Infected Bone Defects

Chen¹,

Li²,

Hou³

et al. 2023

IJN

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Purpose The repair and treatment of infected bone defects (IBD) is a common challenge faced by orthopedic clinics, medical materials science, and tissue engineering. Methods Based on the treatment requirements of IBD, we utilized multidisciplinary knowledge from clinical medicine, medical materials science, and tissue engineering to construct a high-efficiency vancomycin sustained-release system with nanodiamond (ND) and prepare a composite scaffold. Its effect on IBD treatment was assessed from materials, cytology, bacteriology, and zoology perspectives. Results The results demonstrated that the Van-ND-45S5 scaffold exhibited an excellent antibacterial effect, biocompatibility, and osteogenesis in vitro. Moreover, an efficient animal model of IBD was established, and a Van-ND-45S5 scaffold was implanted into the IBD. Radiographic and histological analyses and bone repair-related protein expression, confirmed that the Van-ND-45S5 scaffold had good biocompatibility and osteogenic and anti-infective activities in vivo. Conclusion Collectively, our findings support that the Van-ND-45S5 scaffold is a promising new material and approach for treating IBD with good antibacterial effects, biocompatibility, and osteogenesis.

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“…Surgical and pharmaceutical deadspace management is important to protect the prosthesis from colonisation [ 4 , 6 ]. Although weight-adjusted cefuroxime dosing may provide theoretically adequate prophylactic concentrations, a large and poorly perfused deadspace with a long diffusion distance may inhibit the ability of the immune system to penetrate to the deadspace surrounding the prosthesis [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…PJI is a serious complication following arthroplasty surgery associated with significant morbidity for the patient [ 5 ]. In spite of great advancements in the field of orthopaedic devices and surgical techniques, the introduction of foreign materials is still associated with a substantial risk of infection due to increasing bacterial virulence [ 6 , 7 ]. Staphylococcus aureus ( S. aureus ) remains the most causative aetiology in PJIs [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

High Cefuroxime Concentrations and Long Elimination in an Orthopaedic Surgical Deadspace—A Microdialysis Porcine Study

et al. 2022

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Deadspace is the tissue and bony defect in a surgical wound after closure. This space is presumably poorly perfused favouring bacterial proliferation and biofilm formation. In arthroplasty surgery, an obligate deadspace surrounding the prosthesis is introduced and deadspace management, in combination with obtaining therapeutic prophylactic antibiotic concentrations, is important for limiting the risk of acquiring a periprosthetic joint infection (PJI). This study aimed to investigate cefuroxime distribution to an orthopaedic surgical deadspace in comparison with plasma and bone concentrations during two dosing intervals (8 h × 2). In a setup imitating shoulder arthroplasty surgery, but without insertion of a prosthesis, microdialysis catheters were placed for cefuroxime sampling in a deadspace in the glenohumeral joint and in cancellous bone of the scapular neck in eighteen pigs. Blood samples were collected as a reference. Cefuroxime was administered according to weight (20 mg/kg). The primary endpoint was time above the cefuroxime minimal inhibitory concentration of the free fraction of cefuroxime for Staphylococcus aureus (fT > MIC (4 μg/mL)). During the two dosing intervals, mean fT > MIC (4 μg/mL) was significantly longer in deadspace (605 min) compared with plasma (284 min) and bone (334 min). For deadspace, the mean time to reach 4 μg/mL was prolonged from the first dosing interval (8 min) to the second dosing interval (21 min), while the peak drug concentration was lower and half-life was longer in the second dosing interval. In conclusion, weight-adjusted cefuroxime fT > MIC (4 μg/mL) and elimination from the deadspace was longer in comparison to plasma and bone. Our results suggest a deadspace consolidation and a longer diffusions distance, resulting in a low cefuroxime turn-over. Based on theoretical targets, cefuroxime appears to be an appropriate prophylactic drug for the prevention of PJI.

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Dead Space Management After Orthopaedic Trauma

Abstract: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Cited by 18 publications

References 76 publications

Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model

Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model

The Antibacterial Effect, Biocompatibility, and Osteogenesis of Vancomycin-Nanodiamond Composite Scaffold for Infected Bone Defects

High Cefuroxime Concentrations and Long Elimination in an Orthopaedic Surgical Deadspace—A Microdialysis Porcine Study

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