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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 78 - 78
1 Dec 2019
HIGH-ENERGY FOCUSED EXTRACORPOREAL SHOCKWAVE THERAPY IN ADDITION TO CONVENTIONAL TREATMENT: RESULTS FROM AN IN VIVO RABBIT MODEL OF FRACTURE-RELATED INFECTION
Pützler J Alexander M Everding J Raschke MJ Arens D Zeiter S Richards GR Moriarty FT
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Aim

Focused high energy extracorporeal shockwave therapy (fhESWT) is used to support fracture healing in non-union cases and has been shown to have antibacterial effects. We trialed fhESWT as an adjunct to conventional treatment in a clinically relevant rabbit model of fracture related infection.

Method

A complete humeral osteotomy was performed in 31 rabbits and fixed with a 7-hole-LCP. A fracture-related infection (FRI) was established with Staphylococcus aureus. After two weeks, a revision surgery was performed with debridement, irrigation and implant retention. Rabbits then received: no further treatment (controls); shockwaves (at day 2 and 6 after revision, 4'000 Impulses each time with 23kV); systemic antibiotics (rifampin and nafcillin) over one week in weight adjusted dosages; or the combination of antibiotics and shockwaves. Treatments were applied over one week. Blood cultures were taken before and after shockwave sessions. After an additional week without treatment, rabbits were euthanized, and quantitative bacteriology was performed on implants and tissues to determine infection burden. Indicator organs (brain, heart, liver, lungs, kidneys and spleen) were cultured to assess possible bacteraemia due to fhESWT.

Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 24 - 24
1 Dec 2018
CURRENT PRACTICES IN THE MANAGMENT OF OPEN FRACTURES: A WORLWIDE SURVEY AMONG ORTHOPAEDIC TRAUMA SURGEONS
Pützler J Zalavras C Moriarty F Verhofstad MHJ Stephen K Raschke M Rosslenbroich S Metsemakers W
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Aim

Infection rates after management of open fractures are still high. Existing guidelines regarding prevention of this complication are inhomogeneous. A survey directed to orthopaedic trauma surgeons worldwide aims to give an overview of current practices in the management of open fractures.

Method

An international group of trauma surgeons and infection specialists with experience in the field of musculoskeletal infections developed a questionnaire that was distributed via email to all AOTrauma members worldwide. Descriptive statistical analysis was performed.

Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 63 - 63
1 Dec 2017
DURATION OF ANTIBIOTIC PROPHYLAXIS WITH INTRAVENOUS CEFUROXIME AFFECTS INFECTION RATE WITH STAPHYLOCOCCUS AUREUS IN AN OPEN FRACTURE MODEL IN RABBITS
Pützler J Arens D Metsemakers W Zeiter S Richard K Richards G Raschke M Moriarty F
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Aim

Open fractures still have a high risk for fracture-related Infection (FRI). The optimal duration of perioperative antibiotic prophylaxis (PAP) for open fractures remains controversial due to heterogeneous guidelines and highly variable prophylactic regimens in clinical practice. In order to provide further evidence with which to support the selection of antibiotic duration for open fracture care, we performed a preclinical evaluation in a contaminated rabbit fracture model.

Method

A complete humeral osteotomy in 18 rabbits was fixed with a 7-hole-LCP and inoculated with Staphylococcus aureus (2×106 colony forming units, CFU per inoculum). This inoculum was previously shown to result in a 100% infection rate in the absence of any antibiotic prophylaxis. Cefuroxime was administered intravenously in a weight adjusted dosage equivalent to human medicine (18.75 mg/kg) as a single shot only, for 24 hours (every 8 hours) and for 72 hours (every 8 hours) in separate groups of rabbits (n=6 per group). Infection rate per group was assessed after two weeks by quantitative bacteriological evaluation of soft tissue, bone and implants. Blood samples were taken from rabbits preoperatively and on days 3, 7 and 14 after surgery to measure white blood cell count (WBC) and C-reactive protein (CRP) levels.

Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 102 - 102
1 Dec 2017
EARLY AND DELAYED FRACTURE-RELATED INFECTIONS ARE TREATED SUCCESSFULLY WITH IMPLANT RETENTION IN A RABBIT MODEL OF STAPHYLOCOCCUS AUREUS INFECTION
Pützler J Zeiter S Vallejo A Gehweiler D Raschke M Richards G Moriarty F
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Aim

Treatment regimens for fracture-related infection (FRI) often refer to the classification of Willenegger and Roth, which stratifies FRIs based on time of onset of symptoms. The classification includes early (<2 weeks), delayed (2–10 weeks) and late (>10 weeks) infections. Early infections are generally treated with debridement and systemic antibiotics but may not require implant removal. Delayed and late infections, in contrast, are believed to have a mature biofilm on the implant, and therefore, treatment often involves implant removal. This distinction between early and delayed infections has never been established in a controlled clinical or preclinical study. This study tested the hypothesis that early and delayed FRIs respond differently to treatment comprising implant retention.

Method

A complete humeral osteotomy in 16 rabbits was fixed with a 7-hole-LCP and inoculated with Staphylococcus aureus. The inoculum size (2×106 colony forming units per inoculum) was previously tested without antibiotic intervention to result in infection of all animals persisting for at least 12 weeks.4 The infection was allowed to develop for either 1 (early group) or 4 (delayed group) weeks (n= 8 per group) after bacterial inoculation. At these time points, treatment involved debridement and irrigation of the wound (no implant removal) and quantitative bacteriological evaluation of the removed materials. Systemic antibiotics were administered according to a common clinical regimen (2 weeks: rifampin + nafcillin, followed by 4 weeks: rifampin + levofloxacin). After an additional one-week antibiotic washout period, animals were euthanized and a quantitative bacteriology of soft tissue, implant (after sonication) and bone was performed.