Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection
Aims: Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The British Editorial Society of Bone & Joint Surgery
2024-03-01
|
| Series: | Bone & Joint Research |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.133.BJR-2023-0077.R2 |
| _version_ | 1797228937075490816 |
|---|---|
| author | Jan Puetzler Alejandro Vallejo Diaz Georg Gosheger Martin Schulze Daniel Arens Stephan Zeiter Claudia Siverino Robert G. Richards Thomas F. Moriarty |
| author_facet | Jan Puetzler Alejandro Vallejo Diaz Georg Gosheger Martin Schulze Daniel Arens Stephan Zeiter Claudia Siverino Robert G. Richards Thomas F. Moriarty |
| author_sort | Jan Puetzler |
| collection | DOAJ |
| description | Aims: Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model. Methods:
Staphylococcus aureus was inoculated into a humeral osteotomy in 17 rabbits after plate osteosynthesis. Infection developed for one week (early group, n = 6) or four weeks (delayed group, n = 6) before DAIR (systemic antibiotics: two weeks, nafcillin + rifampin; four weeks, levofloxacin + rifampin). A control group (n = 5) received revision surgery after four weeks without antibiotics. Bacteriology of humerus, soft-tissue, and implants was performed seven weeks after revision surgery. Bone healing was assessed using a modified radiological union scale in tibial fractures (mRUST). Results: Greater bacterial burden in the early group compared to the delayed and control groups at revision surgery indicates a retraction of the infection from one to four weeks. Infection was cleared in all animals in the early and delayed groups at euthanasia, but not in the control group. Osteotomies healed in the early group, but bone healing was significantly compromised in the delayed and control groups. Conclusion: The duration of the infection from one to four weeks does not impact the success of infection clearance in this model. Bone healing, however, is impaired as the duration of the infection increases. Cite this article: Bone Joint Res 2024;13(3):127–135. |
| first_indexed | 2024-04-24T15:04:37Z |
| format | Article |
| id | doaj.art-c80e9fc44bba4f4a9b31bcde118dd37c |
| institution | Directory Open Access Journal |
| issn | 2046-3758 |
| language | English |
| last_indexed | 2024-04-24T15:04:37Z |
| publishDate | 2024-03-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj.art-c80e9fc44bba4f4a9b31bcde118dd37c2024-04-02T13:47:14ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582024-03-0113312713510.1302/2046-3758.133.BJR-2023-0077.R2Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infectionJan Puetzler0https://orcid.org/0000-0002-4943-3398Alejandro Vallejo Diaz1https://orcid.org/0000-0003-4652-542XGeorg Gosheger2https://orcid.org/0000-0003-1089-9972Martin Schulze3https://orcid.org/0000-0003-2899-1558Daniel Arens4https://orcid.org/0000-0002-2705-0812Stephan Zeiter5https://orcid.org/0000-0002-8155-4202Claudia Siverino6https://orcid.org/0000-0002-4845-1922Robert G. Richards7https://orcid.org/0000-0002-7778-2480Thomas F. Moriarty8https://orcid.org/0000-0003-2307-0397AO Research Institute Davos, Davos, SwitzerlandAO Research Institute Davos, Davos, SwitzerlandClinic of General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Münster, GermanyClinic of General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Münster, GermanyAO Research Institute Davos, Davos, SwitzerlandAO Research Institute Davos, Davos, SwitzerlandAO Research Institute Davos, Davos, SwitzerlandAO Research Institute Davos, Davos, SwitzerlandAO Research Institute Davos, Davos, SwitzerlandAims: Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model. Methods: Staphylococcus aureus was inoculated into a humeral osteotomy in 17 rabbits after plate osteosynthesis. Infection developed for one week (early group, n = 6) or four weeks (delayed group, n = 6) before DAIR (systemic antibiotics: two weeks, nafcillin + rifampin; four weeks, levofloxacin + rifampin). A control group (n = 5) received revision surgery after four weeks without antibiotics. Bacteriology of humerus, soft-tissue, and implants was performed seven weeks after revision surgery. Bone healing was assessed using a modified radiological union scale in tibial fractures (mRUST). Results: Greater bacterial burden in the early group compared to the delayed and control groups at revision surgery indicates a retraction of the infection from one to four weeks. Infection was cleared in all animals in the early and delayed groups at euthanasia, but not in the control group. Osteotomies healed in the early group, but bone healing was significantly compromised in the delayed and control groups. Conclusion: The duration of the infection from one to four weeks does not impact the success of infection clearance in this model. Bone healing, however, is impaired as the duration of the infection increases. Cite this article: Bone Joint Res 2024;13(3):127–135.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.133.BJR-2023-0077.R2fracture-related infectionbiofilmdairstaphylococcus aureusbone healingrabbit modelsfracture-related infection (fri)infectionsrevision surgeriesbone healingdebridement, antibiotics, and implant retentionosteotomiesantibioticshumerustibial fractures |
| spellingShingle | Jan Puetzler Alejandro Vallejo Diaz Georg Gosheger Martin Schulze Daniel Arens Stephan Zeiter Claudia Siverino Robert G. Richards Thomas F. Moriarty Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection Bone & Joint Research fracture-related infection biofilm dair staphylococcus aureus bone healing rabbit models fracture-related infection (fri) infections revision surgeries bone healing debridement, antibiotics, and implant retention osteotomies antibiotics humerus tibial fractures |
| title | Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection |
| title_full | Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection |
| title_fullStr | Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection |
| title_full_unstemmed | Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection |
| title_short | Implant retention in a rabbit model of fracture-related infection: similar infection clearance but impaired bone healing in delayed compared to early infection |
| title_sort | implant retention in a rabbit model of fracture related infection similar infection clearance but impaired bone healing in delayed compared to early infection |
| topic | fracture-related infection biofilm dair staphylococcus aureus bone healing rabbit models fracture-related infection (fri) infections revision surgeries bone healing debridement, antibiotics, and implant retention osteotomies antibiotics humerus tibial fractures |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.133.BJR-2023-0077.R2 |
| work_keys_str_mv | AT janpuetzler implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT alejandrovallejodiaz implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT georggosheger implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT martinschulze implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT danielarens implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT stephanzeiter implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT claudiasiverino implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT robertgrichards implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection AT thomasfmoriarty implantretentioninarabbitmodeloffracturerelatedinfectionsimilarinfectionclearancebutimpairedbonehealingindelayedcomparedtoearlyinfection |