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Orthopaedic Proceedings

Vol. 105-B, Issue SUPP_17 | Pages 16 - 16

24 Nov 2023

DEBRIDEMENT, ANTIBIOTICS, IRRIGATION, AND IMPLANT RETENTION IN A SHEEP FRACTURE-RELATED INFECTION MODEL

Siverino C Gens L Ernst M Buchholz T Windolf M Richards G Zeiter S Moriarty F

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Aim

Debridement, Antibiotics, Irrigation, and implant Retention (DAIR) is a surgical treatment protocol suitable for some patients with fracture related infection (FRI). Clinically relevant pre-clinical models of DAIR are scarce and none have been developed in large animals. Therefore, this project aimed to develop a large animal model for FRI including a DAIR approach and compare outcomes after 2 or 5 weeks of infection.

Method

Swiss Alpine sheep (n=8), (2–6 years, 50–80 kg) were included in this study. This study was approved by cantonal Ethical authorities in Chur, Switzerland. A 2 mm osteotomy was created in the tibia and fixed with a 10-hole 5.5 mm steel plate. Subsequently, 2.5 mL of saline solution containing 10⁶ CFU/mL of Staphylococcus aureus MSSA (ATCC 25923) was added over the plate. Sheep were observed for 2 (n=3) or 5 weeks (n=5) until revision surgery, during which visibly infected or necrotic tissues were removed, and the wound flushed with saline. All samples were collected for bacterial quantification. After revision surgery, the sheep were treated systemically for 2 weeks with flucloxacillin and for 4 weeks with rifampicin and cotrimoxazole. After 2 further weeks off antibiotics, the animals were euthanized. Bacteriological culture was performed at the end of the study. Bone cores were isolated from the osteotomy site and processed for Giemsa & Eosin and Brown and Brenn staining. A radiographical examination was performed every second week.

Orthopaedic Proceedings

Vol. 98-B, Issue SUPP_23 | Pages 31 - 31

1 Dec 2016

THE INFLUENCE OF TITANIUM AND STEEL FRACTURE FIXATION PLATES WITH DIFFERENT SURFACE TOPOGRAPHIES ON INFECTION RATES IN A RABBIT FRACTURE MODEL

Metsemakers W Schmid T Zeiter S Ernst M Keller I Cosmelli N Arens D Moriarty F Richards G

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Aim

The aim of this study was to define the role of implant material and surface topography on infection susceptibility in a preclinical in vivo model incorporating appropriate fracture biomechanics and bone healing.

Method

The implants included in this experimental study were composed of: standard Electro polished Stainless Steel (EPSS), standard titanium (Ti-S), roughened stainless steel (RSS) and surface polished titanium (Ti-P). In an in vivo study, a rabbit humeral fracture model was used. Each rabbit received one of three Staphylococcus aureus inocula, aimed at determining the infection rate at a low, medium and high dose of bacteria. Outcome measures were quantification of bacteria on the implant and in the surrounding tissues, and determination of the infectious dose 50 (ID50).

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