Focused high-energy extracorporeal shockwaves as supplemental treatment in a rabbit model of fracture-related infection.
extracorporeal shockwaves
fracture-related infection
osteomyelitis
rabbit model
supplemental treatment
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
10
07
2019
accepted:
03
11
2019
pubmed:
12
12
2019
medline:
25
8
2020
entrez:
12
12
2019
Statut:
ppublish
Résumé
Focused high-energy extracorporeal shockwave therapy (fhESWT) is used to improve fracture healing in cases of nonunion. In addition, it has been shown to have direct antibacterial effects. We evaluated fhESWT as an adjunct to conventional treatment in a clinically relevant rabbit model of fracture-related infection (FRI). A humeral osteotomy in 31 rabbits was fixed with a seven-hole locking compression plate. FRI was established with a clinical Staphylococcus aureus isolate. After 2 weeks, a revision surgery was performed with debridement, irrigation, and implant retention. Rabbits then received: no further treatment (controls); shockwaves (4000 impulses with 23 kV at days 2 and 6 after revision); systemic antibiotics (rifampin and nafcillin); or the combination of antibiotics and shockwaves. Treatments were applied over 1 week. Blood cultures were taken before and after shockwave sessions. After another 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 bacteremia. All the rabbits were infected at revision surgery as determined by the bacteriological culture of debrided materials. fhESWT in combination with antibiotic treatment lowered the bacterial burden 100-fold compared with antibiotic treatment alone in all samples (P = .38). This effect was most prevalent for the implant sample (P = .08). No significant effect was seen for fhESWT alone compared with untreated controls. No signs of bacteremia occurred in blood cultures and organs. fhESWT appears safe and could be a helpful adjunct to conventional treatment in certain difficult-to-treat FRIs.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1351-1358Informations de copyright
© 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Références
O'Brien CL, Menon M, Jomha NM. Controversies in the management of open fractures. Open Orthop J. 2014;8:178-184.
Ryan SP, Pugliano V. Controversies in initial management of open fractures. Scand J Surg. 2014;103:132-137.
Craig J, Fuchs T, Jenks M, et al. Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing. Int Orthop. 2014;38:1025-1030.
Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422-1429.
Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006;37(suppl 2):S59-S66.
Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury. 2011;42:1408-1415.
Schmidmaier G, Kerstan M, Schwabe P, Südkamp N, Raschke M. Clinical experiences in the use of a gentamicin-coated titanium nail in tibia fractures. Injury. 2017;48:2235-2241.
Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg Am. 2010;92:823-828.
Tschudin-Sutter S, Frei R, Dangel M, et al. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention-results from a prospective observational cohort study. Clin Microbiol Infect. 2016;22(457):e451-e459.
Koolen MKE, Kruyt MC, Zadpoor AA, Öner FC, Weinans H, van der Jagt OP. Optimization of screw fixation in rat bone with extracorporeal shock waves. J Orthop Res. 2018;36:76-84.
Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res. 2003;21:984-989.
Lama A, Santoro A, Corrado B, et al. Extracorporeal shock waves alone or combined with raloxifene promote bone formation and suppress resorption in ovariectomized rats. PLoS One. 2017;12:e0171276.
Everding J, Freistühler M, Stolberg-Stolberg J, Raschke MJ, Garcia P. Extrakorporale fokussierte Stoßwellentherapie zur Behandlung von Pseudarthrosen. Der Unfallchirurg. 2017;120:969-978.
Cacchio A, Giordano L, Colafarina O, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am. 2009;91:2589-2597.
Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am. 2010;92:846-854.
Notarnicola A, Moretti L, Tafuri S, et al. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid. Ultrasound Med Biol. 2010;36:1306-1313.
Raschke M, Rosslenbroich S, Everding J. Pseudarthrosen: Immer 6 Monate warten oder muss früher etwas passieren? Trauma und Berufskrankheit. 2017;19:255-259.
Sistermann R, Katthagen BD. [Complications, side-effects and contraindications in the use of medium and high-energy extracorporeal shock waves in orthopedics]. Z Orthop Ihre Grenzgeb. 1998;136:175-181.
Gollwitzer H, Roessner M, Langer R, et al. Safety and effectiveness of extracorporeal shockwave therapy: results of a rabbit model of chronic osteomyelitis. Ultrasound Med Biol. 2009;35:595-602.
Horn C, Gerdesmeyer L, von Eiff C, Gradinger R, Gollwitzer H. Energy-dependent stimulatory and inhibitory effects of extracorporeal shock waves on bacteria and on gentamicin activity. Med Sci Monit. 2009;15:MT77-MT83.
Gerdesmeyer L, von Eiff C, Horn C, et al. Antibacterial effects of extracorporeal shock waves. Ultrasound Med Biol. 2005;31:115-119.
Horn C, Mengele K, Gerdesmeyer L, Gradinger R, Gollwitzer H. The effect of antibacterial acting extracorporeal shockwaves on bacterial cell integrity. Med Sci Monit. 2009;15:BR364-BR369.
Inanmaz ME, Uslu M, Isik C, Kaya E, Tas T, Bayram R. Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant-related chronic osteomyelitis: experimental study in a rat model. J Orthop Res. 2014;32:752-756.
Qi X, Zhao Y, Zhang J, et al. Increased effects of extracorporeal shock waves combined with Gentamicin against Staphylococcus aureusbiofilms in vitro and in vivo. Ultrasound Med Biol. 2016;42:2245-2252.
Arens D, Wilke M, Calabro L, et al. A rabbit humerus model of plating and nailing osteosynthesis with and without Staphylococcus aureus osteomyelitis. Eur Cell Mater. 2015;30:148-161.
Campoccia D, Montanaro L, Moriarty TF, Richards RG, Ravaioli S, Arciola C. The selection of appropriate bacterial strains in preclinical evaluation of infection-resistant biomaterials. Int J Artif Organs. 2008;31:841-847.
Moriarty TF, Campoccia D, Nees SK, Boure LP, Richards RG. In vivo evaluation of the effect of intramedullary nail microtopography on the development of local infection in rabbits. Int J Artif Organs. 2010;33:667-675.
Schmidt AH, Swiontkowski MF. Pathophysiology of infections after internal fixation of fractures. J Am Acad Orthop Surg. 2000;8:285-291.
Horn C, Mengele K, Gerdesmeyer L, Gradinger R, Gollwitzer H. The effect of antibacterial acting extracorporeal shockwaves on bacterial cell integrity. Med Sci Monit. 2009;15:BR364-BR369.
Sabaté Brescó M, O'Mahony L, Zeiter S, et al. Influence of fracture stability on Staphylococcus epidermidis and Staphylococcus aureus infection in a murine femoral fracture model. Eur Cell Mater. 2017;34:321-340.
Moormeier DE, Bose JL, Horswill AR, Bayles KW. Temporal and stochastic control of Staphylococcus aureus biofilm development. mBio. 2014;5:e01341-14.
Metsemakers WJ, Kuehl R, Moriarty TF, et al. Infection after fracture fixation: current surgical and microbiological concepts. Injury. 2018;49:511-522.