Periprosthetic joint infections (PJIs) and osteosynthesis-associated infections (OSIs) present significant challenges in trauma and orthopaedic surgery, substantially impacting patient morbidity, mortality, and economic burden. This concern is heightened in patients with pre-existing comorbidities, such as diabetes mellitus, which are not always modifiable at presentation. A novel intraoperative strategy to prevent these infections is the use of Defensive Antibacterial Coating (DAC), a bio-absorbable antibiotic-containing hydrogel applied to implant surfaces at implantation, acting as a physical barrier to prevent infection.

The purpose of this study is to assess the use of a commercially available hydrogel (DAC), highlighting its characteristics that make it suitable for managing PJIs and OSIs in orthopaedics and traumatology. Twenty-five patients who underwent complex orthopaedic procedures with intraoperative application of DAC between March 2022 and April 2023 at a single hospital site were included. Post-operative assessment encompassed clinical, laboratory, and radiographic examinations.

In this study, 25 patients were included, with a mean age of 70 ± 14.77 years and an average ASA grade of 2.46 ± 0.78. The cohort presented an average Charleston Comorbidity score of 5.45 ± 2.24. The procedures included 8 periprosthetic fractures, 8 foot and ankle surgeries, 5 upper limb surgeries, and 4 elective hip and knee surgeries. Follow-up assessments at 6 weeks and 6 months revealed no evidence of PJI or OSI in any patients, nor were any treatments for PJI or OSI required during the interim period.

DAC demonstrated efficacy in preventing infections in high-risk patients undergoing complex orthopaedic procedures. Our findings warrant further investigation into the use of DAC in complex hosts with randomized control trials.

Introduction: Although a variety of fixation techniques have been reported for fixation of oblique or spiral metacarpal fractures, lag screw fixation has been reported to be the most biomechanically stable method. Lag screws are inserted following over-drilling of the proximal cortex, which provides compression at the fracture site. We believe the compression provided by the Leibinger Bow system makes over-drilling unnecessary.

Methods: Twenty fresh-frozen human cadaveric metacarpal bones (index, ring and middle) were utilised. Bones were cleared of soft tissue and the proximal ends were embedded in Wood’s metal using a Teflon mould. Long oblique osteotomies were performed with a fine oscillating saw. Bones were randomly allocated to lagged and non-lagged groups. All bones were held in the Leibinger Bow and fixed with two screws at right-angles across the fracture site. The proximal cortex of the lagged specimens was over-drilled and the non-lagged specimens were not. The bones were subjected to cantilevered bending to failure in a mechanical testing machine. The axial stress was calculated from results for load to failure and the moment of inertia for each specimen.

Results: All specimens failed through the proximal screw. Analysis of variance statistical analysis revealed no significant difference in axial stress between the two groups.

Conclusions: Minute errors during over-drilling of the proximal cortex can easily lead to inadequate fixation. These data suggest that the use of the Leibinger Bow System may eliminate the need for this over-drilling. This not only shortens the procedure, but also reduces the chance of errors leading to poor fixation.