Antibiotics contribute to the bone healing process
the verdict
INSUFFICIENT LEANING
refutedsupported
the weight of evidence
6 sources for · 0 against
Available studies indicate that antibiotics are utilized in treating fracture-related infections and can be incorporated into scaffolds or treatment regimens to help control infections that would otherwise impede bone healing, though they act primarily by treating or preventing infection rather than directly driving osteogenesis.
Managing fracture infections is a significant challenge in trauma orthopedics, given the limited self‐healing capacity of fractures and the difficulty in eradicating infections. In this study, Cu2MoS4 nanoparticles (CMSs) with are prepared enzyme‐like activity and both pH and near‐infrared (NIR) light responsiveness. These CMSs are combined with methacrylated gelatin (GelMA) to synthesize CMSs hydrogels (CMSs@Gel) with antimicrobial and bone tissue repair‐promoting capabilities. In vitro and in vivo experiments, the CMSs@Gel demonstrated good biocompatibility; peroxidase‐like (POD), oxidase‐like (OXD), and catalase‐like (CAT) activities; excellent photothermal conversion efficiency; and immunomodulatory capacity. Furthermore, the CMSs@Gel exhibited slow degradation, enabling it to exert different pH‐responsive enzyme activities and modulate the production of reactive oxygen species (ROS) and the polarization of macrophages throughout the treatment process. Notably, these effects are significantly enhanced under near‐infrared (NIR) light. Additionally, under NIR irradiation, the CMSs@Gel maintained the fracture environment at a mild temperature (40–42 °C), promoting osteogenesis and angiogenesis. In summary, the CMSs@Gel enhances bactericidal activity during fracture infection and effectively promotes fracture healing after infection control, providing long‐term therapeutic effects. This study offers a robust theoretical basis for the staged and long‐term treatment of fracture infections in the future.
Introduction. Open fractures of the tibial shaft are mostly the result of high-energy trauma, the incidence is 17 to 21 per 100,000 inhabitants, represent 2% of all fractures and 36.7% of all long bone fractures in adults. More than 15% of tibial shaft fractures are classified as open, representing the most common open long bone injuries. The reported incidence of nonunion or delayed union of tibial shaft fractures after intramedullary nailing (IMN) ranges from 16% to 36%. Infection can complicate any stage of the fracture healing process and may contribute to nonunion in up to 38% of cases. Case: A 64yo female with open fracture of the tibial shaft G-A II, initially treated with external fixators, then 3 internal fixations with IMN were performed at different surgical times due to complication of septic nonunion, managed with local and systemic antibiotics and tissue coverage. Discussion: Some orthopedic surgeons prioritize bone union as the main treatment goal in septic nonunion and advocate retaining the implant with surgical cleaning and debridement of devitalized tissue, followed by suppressive intravenous antibiotic therapy. Conversely, others consider eradicating the infectious process as the most critical stage of treatment. Conclusion: Pseudoarthrosis is one of the most devastating problems in orthopedic surgery. We consider it a priority to identify the pathogen associated with the nonunion for specific local and systemic antibiotic therapy associated with aggressiv
Septic Nonunion of the Tibial Shaft with Bone Defect in a Gustilo-anderson Type II Open Fracture | International Journal of Medical Science and Clinical Research Studies International Journal Of Medical Science And Clinical Research Studies ISSN(print): 2767-8326, ISSN(online): 2767-8342 Article Sidebar PDF Published: Dec 14, 2024 DOI: https://doi.org/10.47191/ijmscrs/v4-i12-28 Keywords: Septic Nonunion Tibial Shaft Bone Defect Open Fracture Main Article Content Armando de Jesus Mendoza Kirsch Fourth year traumatology resident, Universidad Autónoma de Yucatán (UADY.) Victor Alayón V. Specialist in traumatology and orthopedics, ISSSTE Susulá, Yucatán, México. Mario Lezama P.
Head of the department of traumatology and orthopedics, ISSSTE Susulá, Yucatán, México. Regina M. Pérez Medical intern, Universidades para el bienestar Benito Juárez Garcia, Ticul, Yucatán. (UBBJ). Abstract Introduction. Open fractures of the tibial shaft are mostly the result of high-energy trauma, the incidence is 17 to 21 per 100,000 inhabitants, represent 2% of all fractures and 36.7% of all long bone fractures in adults. More than 15% of tibial shaft fractures are classified as open, representing the most common
Infection can complicate any stage of the fracture healing process and may contribute to nonunion in up to 38% of cases. Case : A 64yo female with open fracture of the tibial shaft G-A II, initially treated with external fixators, then 3 internal fixations with IMN were performed at different surgical times due to complication of septic nonunion, managed with local and systemic antibiotics and tissue coverage. Discussion : Some orthopedic surgeons prioritize bone union as the main treatment goal in septic nonunion and advocate retaining the implant with surgical cleaning and debridement of devitalized tissue, followed by suppressive intravenous antibiotic therapy.
Conversely, others consider eradicating the infectious process as the most critical stage of treatment. Conclusion : Pseudoarthrosis is one of the most devastating problems in orthopedic surgery. We consider it a priority to identify the pathogen associated with the nonunion for specific local and systemic antibiotic therapy associated with aggressive debridement surgery and stable fixation. Article Details How to Cite Mendoza Kirsch, Armando de Jesus, Victor Manuel Alayón Vázquez, Mario José Lezama Peniche, and Regina Maricruz Pérez Pérez. 2024. “Septic Nonunion of the Tibial Shaft With Bone Defect in a Gustilo-Anderson Type II Open Fracture”.
doi:10.1016/j.injury.2011.10.015 . IV. Agrawal A, Chauhan VD, Maheshwari RK, Juyal AK. Primary nailing in the open fractures of the tibia: Is it worth? J Clin DiagnRes. 2013;7(6):1125-1130. doi:10.7860/JCDR/2013/5504.3081 . V. Mills L, Tsang J, Hopper G, Keenan G, Simpson AHRW. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res. 2016;5(10):512-519. doi:10.1302/2046-3758.510. BJR-2016-0138 . VI. Rupp M, Kern S, Weber T, Menges TD, Schnettler R, Heiß C, Alt V. Polymicrobial infections and microbial patterns in infected nonunions: A descriptive analysis of 42 cases. BMC Infect Dis. 2020;20:667.
Makridis KG, Tosounidis T, Giannoudis PV. Management of infection after intramedullary nailing of long bone fractures: Treatment protocols and outcomes. Open Orthop J. 2013;7:219-226. doi:10.2174/1874325001307010219 . XIV. Zhang HA, Zhou CH, Meng XQ, Fang J, Qin CH. Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: A retrospective study of 19 cases. BMC Musculoskelet Disord. 2020;21:710. doi:10.1186/s12891-020-03734-z . XV. Finelli CA, dos Reis FB, Fernandes HA, Dell’Aquila A, Carvalho R, Miki N, et al.
Intramedullary reaming modality for management of postoperative long bone infection: A prospective randomized controlled trial in 44 patients. Patient Saf Surg. 2019;13:39. doi:10.1186/s13037-019-0215-3. XVI. Tsang STJ, Mills LA, Frantzias J, Baren JP, Keating JF, Simpson AHRW. Exchange nailing for nonunion of diaphyseal fractures of the tibia: Our results and an analysis of the risk factors for failure. Bone Joint J. 2016;98-B(4):534-541. doi:10.1302/0301620X.98B4.34870 . XVII. McNally M, Govaert G, Dudareva M, Morgenstern M, Metsemakers WJ. Definition and diagnosis of fracture-related infection. EFORT Open Rev. 2020;5(10):614-619. doi:10.1302/2058-5241.5.190072 .
Antibiotic penetration into bone in relation to the immediate management of open fractures: a review. Bone is a vascular structure, which is capable of responding to changes in the systemic circulation. Antibiotics carried within the systemic circulation reach the capillaries in bone, and depending on molecular size, pass through the capillary walls to enter the fluid space. Following an open fracture, contamination with pathogenic organisms can occur both at the moment of injury, but also in the hospital, which is a particular problem in grade III fractures in which extensive soft tissue damage can occur in combination with an exposed wound. Antibiotics administered intravenously can be measured in bone by both bioassay and radioactive isotope techniques and are shown to reach bone in effective concentrations. It is apparent that short-course high-dose antibiotic therapy is appropriate for open fractures, and need not be continued as long as the normal fracture-healing process continues. However if infection in bone develops, further surgery is important to remove new dead tissue to allow adequate antibiotic penetration into bone.
Subacute osteomyelitis presenting as bone tumors.
The problem of the differential diagnosis between subacute osteomyelitis and primary bone tumors is a difficult one. Presenting symptoms, duration of disease, laboratory data, and location of the pathologic process are of little assistance. The authors reviewed eight typical cases. Preoperative diagnosis included benign and malignant bone tumors, as well as osteomyelitis; but the final diagnosis of osteomyelitis was made only after open biopsy and culture. The presenting symptoms and signs included: pain, usually dull; soft tissue mass; and, rarely, low grade fever. The radiographic features were usually a lytic area with various degrees of sclerotic reaction. White blood count and sedimentation rate were not helpful. The treatment, including surgical curettage and appropriate antibiotic therapy, resulted in resolution of the process and healing of the bony defects.
Published in Orthopedics (1989)
Abstract Bone is a complex structure with unique cellular and molecular process in its formation. Bone tissue regeneration is a well-organized and routine process at the cellular and molecular level in humans through the activation of biochemical pathways and protein expression. Though many forms of biomaterials have been applied for bone tissue regeneration, electrospun nanofibrous scaffolds have attracted more attention among researchers with their physicochemical properties such as tensile strength, porosity, and biocompatibility. When drugs, antibiotics, or functional nanoparticles are taken as additives to the nanofiber, its efficacy towards the application gets increased. Polyphenol is a versatile green/phytochemical small molecule playing a vital role in several biomedical applications, including bone tissue regeneration. When polyphenols are incorporated as additives to the nanofibrous scaffold, their combined properties enhance cell attachment, proliferation, and differentiation in bone tissue defect. The present review describes bone biology encompassing the composition and function of bone tissue cells and exemplifies the series of biological processes associated with bone tissue regeneration. We have highlighted the molecular mechanism of bioactive polyphenols involved in bone tissue regeneration and specified the advantage of electrospun nanofiber as a wound healing scaffold. As the polyphenols contribute to wound healing with their antioxidant and antimicrobial
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Bone tissue regeneration is a well-organized and routine process at the cellular and molecular level in humans through the activation of biochemical pathways and protein expression. Though many forms of biomaterials have been applied for bone tissue regeneration, electrospun nanofibrous scaffolds have attracted more attention among researchers with their physicochemical properties such as tensile strength, porosity, and biocompatibility. When drugs, antibiotics, or functional nanoparticles are taken as additives to the nanofiber, its efficacy towards the application gets increased.
We have highlighted the molecular mechanism of bioactive polyphenols involved in bone tissue regeneration and specified the advantage of electrospun nanofiber as a wound healing scaffold. As the polyphenols contribute to wound healing with their antioxidant and antimicrobial properties, we have compiled a list of polyphenols studied, thus far, for bone tissue regeneration along with their in vitro and in vivo experimental biological results and salient observations. Finally, we have elaborated on the importance of polyphenol-loaded electrospun nanofiber in bone tissue regeneration and discussed the possible challenges and future directions in this field.
Polyphenols demarcate the inflammatory responses, control the osteoclast’s activation process, and activate the osteoblast’s production through various signaling proteins such as RANKL, osteoprotegerin (OPG), etc. [ 17 ]. Fig. 1 Demonstration of molecular signaling pathways of polyphenols involved in bone tissue regeneration.
b Though polyphenols alone can help bone tissue regeneration, electrospun nanofiber containing polyphenols shows enhanced wound healing due to the sustained release of bioactive molecules from the scaffold The advantage of electrospun nanofibers as a drug carrier is that a greater number of drugs can be encapsulated into the scaffold compared to other forms of nanocarriers such as micelles, nanoparticles, hydrogels, etc. [ 29 ]. Further, the nanofibers can demonstrate a sustained drug release preserving the bioavailability of active drugs like polyphenols [ 4 , 34 ], antibiotics [ 35 ], oligopeptides [ 36 ], medicative ingredients [ 37 ], and growth factors [ 38 ].
Osteogenic cells, osteocytes, osteoclasts, and osteoblast are the primary bone cells involved in bone remodeling and formation [ 48 ] Bone tissue regeneration is the critical process to maintain the bone mass by repairing and regeneration. For years, 25% of trabecular bone and 3% of cortical bone have been removed and replaced through the bone regeneration process in human beings [ 52 ]. Inflammation, renewal, and bone remodeling are the three interconnecting phases involved in the bone tissue regeneration process. The inflammatory phase begins within 24 h of bone fracture or damage and continues up to a week.
The current situation demands the fabrication of highly bioactive scaffolds with superior biocompatibility, mechanical properties, and remodeling potential to repair the damaged tissues. The same can be achieved by either surface functionalization or incorporation of bioactive materials in the nanofiber membrane. The nanofiber scaffold’s primary goal is to provide an appropriate microenvironment for bone tissue to restore and facilitate the bone tissue regeneration process [ 84 ]. Ideally, the fabrication of polyphenol-loaded electrospun nanofibers scaffolds has some advantages in bone tissue regeneration applications.
They exert anti-inflammatory and antioxidant activity, improve bioavailability, and release the polyphenols at a sustained level in the cell differentiation site. They provide an active shield against infection, minimize toxicity to other tissues, and enhance the bone remodeling process via calcium deposition and activation of several bone-specific proteins [ 85 ]. The incorporated biomolecules into the scaffold can interact with the biomaterial’s surface through various physical and chemical forces, including hydrogen bonding, hydrophobic interaction, and Van der Waals force [ 86 ].
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