Infection development in open distal tibial fractures: A comparison of standard titanium plate applications with silver-coated titanium plate applications

Öz

Aim: In this study, we aimed to compare standard titanium plates and silver-Coated titanium plates used for osteosynthesis in open distal tibial fractures, in terms of infection development. Methods: We investigated the development of infection in 216 patients who were operated on based on the principles of biological fixation for Gustilo-Anderson Type 1 and type 2 open distal tibial fractures between 2008 and 2016. 

Standard titanium plates were used in 112 patients (51.9%) (Group 1) and silver-coated titanium plates were used in 104 patients (48.1%) (Group 2). In Group 1, 68 patients had Type 1 and 44 patients had Type 2 open fractures. In Group 2, 58 patients had Type 1, 46 patients had Type 2 open fractures. Results: Infection developed in sixteen patients in Group 1 (five patients with Type 1 and eleven patients with Type 2 fractures, 14.3%) and in three patients (2.9%) with Type 2 open fractures in Group 2. The development of infection was significantly lower in the group that underwent osteosynthesis using silver-coated titanium plates (p<0.05). No statistically significant difference was detected between the groups in terms of time to union (p>0.05). 17 patients in Group 1 and 22 patients in Group 2 had delayed union. There were no statistical differences between two groups in terms of case numbers showing delayed union (p>0.05). Delayed union was observed in all patients who developed infection. Conclusion: Osteosynthesis of open distal tibial fractures with silver-coated titanium plates was found to be effective in preventing infection. Based on our observations, coating the implant with silver did not have any impact on fracture union.

Anahtar Kelimeler

• Open fractures,osteosynthesis,infection,biofilm,silver

Açık distal tibia kırıklarında enfeksiyon gelişimi: Standart titanyum plak ile gümüş kaplı titanyum plak uygulamaları karşılaştırması

Öz

Amaç: Bu çalışmada, standart titanyum plak ve gümüş kaplı titanyum plak ile osteosentez yapılan açık distal tibia kırıklarında enfeksiyon gelişimini karşılaştırmayı amaçladık. Yöntem: Gustilo-Anderson tip 1 ve tip 2 açık distal tibia kırığı nedeniyle 2008-2016 tarihleri arasında biyolojik tesbit prensipleri ile ameliyat edilen ve iki yılın üzerinde takibi yapılan 216 olguda enfeksiyon gelişimi araştırıldı. Standart distal tibia titanyum plak 112 (%51.9) hastada (Grup 1), gümüş kaplı distal tibia titanyum plak 104 (%48.1) hastada (Grup 2) kullanıldı. Grup 1 de 68 hastada tip 1, 44 hastada tip 2 açık kırık vardı. Grup 2 de ise 58 hastada tip tip 1, 46 hastada tip 2 açık kırık mevcuttu. Bulgular: Grup 1 de 16 (tip 1’de beş hasta, tip 2’de onbir hasta, %14.3) hastada, Grup 2 de tip 2 açık kırıklı üç (%2.9) hastada enfeksiyon gelişti. Enfeksiyon gelişimi gümüş kaplı titanyum plak ile osteosentez yapılan grupta anlamlı derecede düşük bulundu (p<0.05). Gruplar arasında kaynama süreleri açısından istatistiksel fark bulunmadı (p>0.05).  Grup 1’de 17 hasta, Grup 2’de 22 hastada kaynama gecikmesi tesbit edildi. İki grup arasında kaynama gecikmesi gösteren olgu sayıları açısından istatistiksel fark yoktu (p>0.05). Enfeksiyon gelişen hastalarda aynı zamanda kaynama gecikmesi de saptandı. Sonuç: Gümüş kaplı titanyum plak ile açık distal tbia kırıklarının osteosentezi enfeksiyonu önlemede etkin bulundu. İmplantın gümüş ile kaplanmasının kırık kaynaması üzerinde etkisi tesbit edilmedi.

Anahtar Kelimeler

• Açık kırıklar,osteosentez,enfeksiyon,biyofilm,gümüş

Destekleyen Kurum

Destekleyen kurum yoktur

Kaynakça

1. 1. Olson SA, Finkemeier CG, Moehring HD. Open Fractures. In: Bucholz RW, Heckman JD, Eds., Rockwood and Green’s Fractures in Adults, 5th Ed., Philadelphia, Lippincott Williams&Wilkins, 2001:285-319.
2. 2. Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am 1990;72:299–304.
3. 3. Rhinelander FW. Tibial blood supply in relation to fracture healing. Clin Orthop Relat Res 1974;105:34-81.
4. 4. Patzakis MS, Wilkins J, Moore TM. Considerations in reducing the infection rate in open tibial fractures. Clin Orthop Relat Res 1983;36-41.
5. 5. Rüedi T, Webb JK, Allgöwer M. Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft. Injury 1976;7(4):252-257.
6. 6. Worlock P, Slack R, Harvey L, Mawhinney R. The prevention of infection in open fractures: an experimental study of the effect of fracture stability. Injury 1994;25(1):31-38.
7. 7. Laga M, Meheus A, Piot P. Epidemiology and control of gonococcal ophthalmia neonatorum. Bulletin of the World Health Organization 1989;67(5):471-478.
8. 8. Klase HJ. Historical review of the use of silver in the treatment of burns. I. Early uses. Burns 2000;26:117–130.

9. 9. Hardes J, Ahrens H, Gebert C, Streitbuerger A, Buerger H, Erren M, Gunsel A, Wedemeyer C, Saxler G, Winkelmann W, Gosheger G. Lack of toxicological side-effects in silver-coated megaprostheses in humans. Biomaterials 2007;28(18):2869–2875.
10. 10. Burges AR, Brumback RJ, Bosse MJ. Management of open grade III tibial fractures. Orthop Clin North Am 1987;18(1):85–89.
11. 11. Wagner M. General principles for the clinical use of the LCP. Injury 2003;34 Suppl 2:B31-42.
12. 12. Tornetta P III, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of Grade IIIB open tibial fractures: A prospective randomised comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg 1994;76(1):13-19.
13. 13. Egol KA, Kubiak EN, Fulkerson E, et al. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488-493.
14. 14. Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br 2006;88:281-289.
15. 15. Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 1989;(241):89-94.
16. 16. Kayali, C, Aguş, H, Eren, A, Ozluk, S. How should open tibia fractures be treated? A retrospective comparative study between intramedullary nailing and biologic plating. Turkish journal of trauma & emergency surgery 2009;15(3);243-248.
17. 17. Gallo J, Holinka M, Moucha CS. Antibacterial surface treatment for orthopaedic implants. Int J Mol Sci 2014;15(8):13849-13880.
18. 18. Zhao L, Wang H, Huo K, Cui L, Zhang W, Ni H, Zhang Y, Wu Z, Chu PK. Antibacterial nano-structured titania coating incorporated with silver nanoparticles. Biomaterials 2011;32(24):5706-5716.
19. 19. Goodman SB, Yao Z, Keeney M, Yang F. The future of biologic coatings for orthopaedic implants. Biomaterials 2013;34(13):3174-83.
20. 20. Alt V, Bechert T, Steinrücke P, Wagener M, Seidel P, Dingeldein E, Domann E, Schnettler R. An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement. Biomaterials 2004;25(18):4383-4391.
21. 21. Chen Y, Zheng X, Xie Y, Ding C, Ruan H, Fan C. Anti-bacterial and cytotoxic properties of plasma sprayed silver containing HA coatings. J Mater Sci Mater Med 2008;19(12):3603–3609.
22. 22. Chen W, Liu Y, Courtney HS, Bettenga M, Agrawal CM, Bumgardner JD, Ong JL. In vitro anti-bacterial and biological properties of magnetron cosputtered silver-containing hydroxyapatite coating. Biomaterials 2006;27(32):5512–5517.
23. 23. Schierholz JM, Lucasj LJ, Rump A, Pulverer G. Efificacy of silver-coated medical device. J Hosp Infect 1998;40(4):257–262.
24. 24. Liau SY, Read DC, Pugh WJ, Furr JR, Russell AD. Interaction of silver nitrate with readily identifiable groups: relationship to the antibacterial action of silver ions. Lett Appl Microbiol 1997;25(4):279–283.
25. 25. Pal S, Tak YK, Song JM. Does the antibacterial activity of silver nanoparticles depend on the shape of the nanoparticle? A study of the Gram-negative bacterium Escherichia coli. Appl Environ Microbiol 2007;73(6):1712-1720.
26. 26. Shimazaki T, Miyamoto H, Ando Y, Noda I, Yonekura Y, Kawano S, Miyazaki M, Mawatari M, Hotokebuchi T. In vivo antibacterial and silver-releasing properties of novel thermal sprayed silver-containg hydroxyapatite coating. J Biomed Mater Res Part B: Appl Biomater 2010 92(B):386-389.
27. 27. Fung MC, Bowen DL. Silver products for medical indications: Risk-benefit assessment. Clinical Toxicology 34; 1:119–126.
28. 28. Wan AT, Conyers RAJ, Coombs CJ, Masterton PB. Determination of silver in blood, urine, and tissues of volunteers and burn patients. Clin Chem 1991;37(10 Pt 1):1683-1687.
29. 29. Seçinti KD, Attar A, Seçinti E. Clinical Trial Using A Silver-Coated Screw-Rod System and One-Year Follow-Up of The First 50 Patients. Sinir Sistemi Cerrahisi Derg 2016;6(1-2):10-21.