Long-term survival and favourable outcome of implant use are determined by bone-implant osseointegration and absence of infection near the implants. As with most diseases, prevention is the preferred approach. Silver ion doped calcium phosphate based ceramic coating (Silveron®) for implant coating has been shown previously to be a potent antimicrobial agent as indicated by in vitro testing. The present study reports on clinical experience using silver ion doped calcium phosphate based ceramic coated external fixator pins as surgical treatment in the management of chronic osteomyelitis and open fractures. Ten patients had external fixators: six for open fractures of ankle, three for chronic osteomyelitis of the femur, one for tibia pseudoarthrosis. The electrospray method was used for coating the external fixator pins with silver ion doped calcium phosphate-based ceramics. A radiofrequency energy source was used to sinter the coated pins. Microbiological, roentgenographic, toxic and biochemical analyzes of patients were carried out. Wound debridement, and subsequent wound care resulted in control of the infection in three chronic osteomyelitis and in healing of seven fractures after follow-up ranging from three to six months. In total 67 pins were used in 10 patients but only one pin was positive microbiologically in one patient. Collectively, these data clearly illustrate that the toxic effects of silver were not observed at the doses used. Silver ion doped calcium phosphate based ceramic coating (Silveron®) can be used to prevent infection associated with the implant.

The aim of this retrospective study was to assess the effects of several preoperative and intraoperative factors on the final clinical and radiological outcomes in pediatric hip fractures.

Forty-four pediatric patients with a hip fracture were treated at our department between January 1998 and September 2007. Thirty-nine patients with a minimum follow-up period of 1 year were included the study. Three patients had inadequate follow-up and two died at the early postoperative period. Mean age of 39 patients were 11.1 (4–16) years. There were 22 boys and 17 girls. The two main etiologic factors were traffic accident and fall from height. Associated injury was present in 15 patients and the pelvis and distal radius fractures were the two most common. The type of the hip fracture according to the Delbet classification was type II in 21, type III in 14 and type IV in 4 patients. Two patients were treated by a hip spica under general anesthesia and 37 were surgically treated by internal fixation using mostly 3 cancellous screws. Ratliff’s clinical and radiological assessment system was used to assess the final outcome and Ratliff’s classification was used for grading the avascular necrosis of the femoral head (AVN). The effects of patient age, gender, fracture type, fracture displacement, laterality, intervention time and capsulotomy on the final outcome were evaluated and a P value less than 0.05 was considered significant.

Mean follow-up was 3.1 (1–9.5) years and the final outcome was satisfactory (good) in 28 (72%) and unsatisfactory (fair or poor) in 11 (28%) patients. AVN was observed in 11 (28%) patients. No significant correlation was found between the final outcome and age (< =10 yrs vs. > 10 yrs; P=0.288), laterality (P=0.477), gender (P=0.158), intervention time (< =24 hours vs. > 24 hours; P=1.0), capsulotomy (P=0.609) or amount of displacement (displaced vs. non-displaced; P=0.078). However, there was a significant correlation between the final outcome and fracture type (worst in type II; P=0.014).

The risk of AVN is nearly 30% in pediatric hip fractures and it is the main determinant of the final outcome. The final radiological and clinical outcomes are correlated significantly with fracture type. Besides, fracture displacement may influence the final outcome. As, cervical femoral neck fractures (mainly displaced) have a higher risk of unsatisfactory outcome in children, the patients and parents should initially be warned about this subject.

Arthrography is a valuable diagnostic tool in pediatric orthopaedics. Although it is considered safe for systemic use of water-soluble contrast media, toxicities in some tissues have been identified.

The goal of this study is to describe the ultrastructural alterations induced by intra-articular two water soluble contrast media, namely Dimeglumine and Iopromide, in rabbit joint cartilage.

60 rabbit knees were used in this study, 20 receiving 1 ml injections of Dimeglumine, 20 receiving 1 ml injections of Iopromide and the remainder of the knees served as control and injected 1 ml physiological saline. The animals were killed after 1 hour, 1 day, 1 week and 2 weeks and a specimen of the knee cartilage were immersed in to %5 Glutaraldehyde + Phosphate buffer solution and fixed for overnight at +5° C. Tissues were postfixed in %1 Osmium Tetroxide solution for 1 hour and samples were routinely proccessed for electron microscopy.

In the knees injected with SF, the cartilage appeared normal on transmission EM examination and only rare chondrocytes with small glycogen and lipid vacuoles were observed, whereas in those injected with Dimeglumine and Iopromide, increased activation of cells, glycogen and lipid accumulation, collagen fibrils in matrix and especially in those injected with Iopromide decreased matrix around the cells were present in the cartilage. There were very rare picnotic cells in these samples. Contrast agents have local effects as well as systemic effects. In this study detrimental local effects of contrast agents have been demonstrated by high dose exposure in rabbit joint cartilage. We concluded that further work is needed to determine if these effects are of clinical importance.