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Background: Infection is one of the main reasons for failure of orthopedic implants. Antibacterial coatings may prevent bacterial adhesion and biofilm formation, according to various preclinical studies. The aim of the present study is to report the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) to prevent surgical site infection, in patients undergoing internal osteosynthesis for closed fractures.Materials and Methods: In this multicenter randomized controlled prospective study, a total of 256 patients in five European orthopedic centers who were scheduled to receive osteosynthesis for a closed fracture, were randomly assigned to receive antibiotic-loaded DAC or to a control group (without coating). Pre- and postoperative assessment of laboratory tests, wound healing, clinical scores and X-rays were performed at fixed time intervals.Results: Overall, 253 patients were available with a mean follow-up of 18.1 ± 4.5 months (range 12-30). On average, wound healing, clinical scores, laboratory tests and radiographic findings did not show any significant difference between the two groups. Six surgical site infections (4.6%) were observed in the control group compared to none in the treated group (P < 0.03). No local or systemic side-effects related to the DAC hydrogel product were observed and no detectable interference with bone healing was noted.Conclusions: The use of a fast-resorbable antibiotic-loaded hydrogel implant coating provides a reduced rate of post-surgical site infections after internal osteosynthesis for closed fractures, without any detectable adverse event or side-effects.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Objective: The aim: To study was to use mathematical modeling in assessing the stress-strain state of the bone-implant system during plate osteosynthesis with a PHILOS plate of a proximal humerus fracture with polylactic acid implants., Patients and Methods: Materials and methods: Two bone-implant systems with a three-fragment humerus fracture according to the Neer classification (type 11-C1 according to the AO / ASIF classification) were selected for the study, one of which was with additional reinforcement of the head fragment with two polylactic acid implants (PLA - polylactide Ingeo™ Biopolymer 4032D). Sawbones (Europe AB, Malmö, Sweden) built the humeral model on 3D scanning of the composite model № 3404 of the left humerus., Results: Results: A comparative analysis of the obtained results of mathematical modeling of the stress-strain state of the bone-implant systems showed that with given constraints (hand abduction to 90°), the use of two polylactic acid implants can reduce the stress in the plate and screws, respectively, by 11% and 6% ., Conclusion: Conclusions: The use of polylactic acid implants during osteosynthesis of three- and four-fragment fractures of the proximal humerus, especially in the case of osteoporosis, allows providing for the reinforcement of metal structures and supporting of the articular surface without deterioration of fixation rigidity.

Diaphyseal fractures of the forearm have accompanied humanity throughout its history. Nonsurgical techniques dominated the treatment for centuries, and complications including nonunion and malunion were common. The 19th century featured the recognition of distinct injury patterns. With the development of anesthesia and antisepsis, the operative treatment became widespread. In 1878, Heine described fixation of the diaphyseal nonunion of the distal ulna using an intramedullary ivory peg. Parkhill reported on the application of external fixation for forearm fractures in 1897-1898. Hansmann published the case of plate osteosynthesis of an acute fracture of the radius in 1886. In 1913, Schöne published the technique of closed intramedullary fixation of diaphyseal fractures of the forearm using a silver wire. During the first 2 decades of the 20th century, plate osteosynthesis quickly spread across Europe and North America owing to the influence of Lambotte and Lane. After the World War II, plate osteosynthesis became the surgical treatment of choice for forearm diaphyseal fractures., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)