[Effectiveness of limbs shortening and re-lengthening in treatment of tibial infectious bone defect and chronic osteomyelitis]

Carbon Nanomaterials in the Treatment of Infectious Bone Defects and Wound Scars after Wushu Fractures

Although modern antibiotics and surgical technology have made great progress, when using carbon nanomaterials to treat bone marrow-induced inflammation after martial arts fractures, how to simultaneously repair bone defects and control wound infections is the current focus of orthopedics research. This paper uses electrospinning technology to develop a carbon nanomaterial based on PLA, HA-g-PLA, and vancomycin. The surface morphology, biocompatibility, drug release, and osteogenesis of carbon nanomaterials are studied, selecting animal models to verify its effect in the treatment of osteomyelitis with bone defects and provide new ideas and new methods for the treatment of bone defects complicated by osteomyelitis infection. In this paper, carbon nanofibers containing doxycycline, a small molecule protease inhibitor, were prepared by simple blending. Encapsulation of carbon nanofibers can control the slow release of doxycycline and improve the effect of doxycycline in treating chronic wounds. This article uses two methods to prepare different types of osteomyelitis models and compare them. After injecting saline or bacterial solution, the two groups were sealed with bone wax and the incision was closed; the blank group did not do any treatment. Within 30 days after surgery, the appearance of the left hind limb wound and general signs of infection were closely monitored, body temperature was measured, and blood was collected from the ear veins of experimental animals to analyze the changes in C-reactive protein (CRP) and procalcitonin levels (PCT); X-ray, CT imaging, and histological observation were performed on 14 and 28 days. Studies have shown that when the drug loading of doxycycline increases from 10% to 15%, this is related to the change in properties of the polylactic acid fiber membrane from hydrophobic to hydrophilic caused by the increase in doxycycline drug loading.

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Background

The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the safety and efficacy between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects.

Methods

A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The modified Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Standard mean difference (SMD) was used for continuous variables and relative risk (RR) for the binary variables. All of the variables included its 95% confidence interval (CI).

Results

Five studies, including a total of 199 patients, were included in the study. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P < 0.00001); however, no significance was observed in bone union time (SMD = − 0.02, 95% CI: − 0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37).

Conclusions

AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.