Polishing the surface of internal fracture fixation (IFF) implant materials can ease implant removal and reduce irritation to gliding tissues by reducing soft tissue adhesion and bony overgrowth. Thus, polishing the surface of these implants is expected to have significant clinical benefit in certain situations. The aim of the present study was to determine if polishing the surface of an IFF device influences susceptibility to infection.
The local infection rate associated with 4-hole 2.0 mm Synthes® locking compression plates (LCPs) composed of clinically available commercially pure titanium (cpTi) and titanium aluminium niobium (TAN) in their standard microrough form was compared with that of their test polished equivalents and also to clinically available electropolished stainless steel (EPSS). The LCPs were fixed in locking mode onto the tibia of mature, female New Zealand White rabbits and a clinical strain of Staphylococcus aureus was added to the implantation site. Twenty eight days after surgery the rabbits were euthanized and assessed for infection. The rank order based on descending ID50 was; polished TAN, standard TAN, standard cpTi, EPSS and finally polished cpTi, however, the ID50 values did not differ greatly between the groups with the same material. Using the LCP model in locking mode, polishing the surface of both cpTi and TAN was not found to influence the susceptibility to infection in our animal model.
ArensS., EijerH., SchlegelU., PrintzenG., PerrenS.M., HansisM.. Influence of the design for fixation implants on local infection: experimental study of dynamic compression plates versus point contact fixators in rabbits.J Orthop Trauma1999; 13: 470–6.
2.
MelcherG.A., ClaudiB., SchlegelU., PerrenS.M., PrintzenG., MunzingerJ.. Influence of type of medullary nail on the development of local infection. An experimental study of solid and slotted nails in rabbits.J Bone Joint Surg (Br)1994; 76: 955–9.
3.
BoxmaH., BroekhuizenT., PatkaP., OostingH.. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial.Lancet1996; 347: 1133–7.
4.
BoxmaH.. Wound infections in fracture surgery.University of Amsterdam Thesis; 1995.
5.
McGrawJ.M., LimE.V.. Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing.J Bone Joint Surg (Am)1988; 70: 900–11.
6.
ObremskeyW.T., BhandariM., DirschlD.R., ShemitschE.. Internal fixation versus arthroplasty of comminuted fractures of the distal humerus.J Orthop Trauma2003; 17: 463–5.
7.
RaahaveD.. Postoperative wound infection after implant and removal of osteosynthetic material.Acta Orthop Scand1976; 47: 28–35.
8.
GristinaA.G.. Implant failure and the immuno-incompetent fibro-inflammatory zone.Clin Orthop Relat Res1994; 298: 106–18.
9.
Mayberry-CarsonK.J., Tober-MeyerB., SmithJ.K., LambeD.W.Jr.., Costerton JW.Bacterial adherence and glycocalyx formation in osteomyelitis experimentally induced with Staphylococcus aureus. Infect Immun1984; 43: 825–33.
WilliamsI., VenablesW.A., LloydD., PaulF., CritchleyI.. The effects of adherence to silicone surfaces on antibiotic susceptibility in Staphylococcus aureus.Microbiology1997; 143(Pt 7): 2407–13.
12.
DarouicheR.O.. Treatment of infections associated with surgical implants.N Engl J Med2004; 350: 1422–9.
13.
GristinaA.G.. Biomaterial-centered infection: microbial adhesion versus tissue integration.Science1987; 237: 1588–95.
14.
LowryK.J., GainorB.J., HoskinsJ.S.. Extensor tendon rupture secondary to the AO/ASIF titanium distal radius plate without associated plate failure: a case report.Am J Orthop2000; 29: 789–91.
15.
SinicropiS.M., SuB.W., RaiaF.J., ParisienM., StrauchR.J., RosenwasserM.P.. The effects of implant composition on extensor tenosynovitis in a canine distal radius fracture model.J Hand Surg (Am)2005; 30: 300–7.
16.
HayesJ.S., VosD.I., HahnJ., PearceS.G., RichardsR.G.. Effect of surface polishing of TAN intramedullary nails upon bone tissue adhesion and ease of nail removal - an in vivo study. 54th Orthopaedic Research Society Conference, San Francisco, USA 2008; 33. p 1044.
17.
PearceA.I., PearceS.G., SchweigerK.. Effect of surface topography on removal of cortical bone screws in a novel sheep model.J Orthop Res2008; 26: 1377–83.
18.
WeltonJ.L.. In vivo evaluation of defined polished surfaces to prevent soft tissue adhesion. Master thesis. University of Wales, Aberystwyth; 2006.
19.
BollenC.M., LambrechtsP., QuirynenM.. Comparison of surface roughness of oral hard materials to the threshold surface roughness for bacterial plaque retention: a review of the literature.Dent Mater1997; 13: 258–69.
20.
HarrisL.G., RichardsR.G.. Staphylococcus aureus adhesion to different treated titanium surfaces.J Mater Sci Mater Med2004; 15: 311–14.
21.
HarrisL.G., MeredithD.O., EschbachL., RichardsR.G.. Staphylococcus aureus adhesion to standard micro-rough and electropolished implant materials.J Mater Sci Mater Med2007; 18: 1151–6.
22.
QuirynenM., BollenC.M.. The influence of surface roughness and surface-free energy on supra- and subgingival plaque formation in man. A review of the literature.J Clin Periodontal1995; 22: 1–14.
23.
ArensS., SchlegelU., PrintzenG.. Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits.J Bone Joint Surg (Br)1996; 78: 647–51.
24.
WorlockP., SlackR., HarveyL., MawhinneyR.. The prevention of infection in open fractures: an experimental study of the effect of fracture stability.Injury1994; 25: 31–8.
25.
ArciolaC.R., BaldassarriL., Von EiffC.. Prevalence of genes encoding for staphylococcal leukocidal toxins among clinical isolates of Staphylococcus aureus from implant orthopedic infections.Int J Artif Organs2007; 30: 792–7.
26.
CampocciaD., BaldassarriL., PiriniV., RavaioliS., MontanaroL., ArciolaC.R.. Molecular epidemiology of Staphylococcus aureus from implant orthopaedic infections: Ribotypes, agr polymorphism, leukocidal toxins and antibiotic resistance.Biomaterials2008; 29: 4108–16.
27.
StepanovicS., VukovicD., DakicI., SavicB., Svabic-VlahovicM.. A modified microtiter-plate test for quantification of staphylococcal biofilm formation.J Microbiol Methods2000; 40: 175–9.
28.
PeacockS.J., MooreC.E., JusticeA.. Virulent combinations of adhesin and toxin genes in natural populations of Staphylococcus aureus.Infect Immun2002; 70: 4987–96.
29.
MilesA.A., MisraS.S.. The estimation of the bactericidal power of the blood.J Hyg1938; 38: 732–49.
30.
MurchanS., KaufmannM.E., DeplanoA.. Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus.J Clin Microbiol2003; 41: 1574–85.
31.
HornJ., SchlegelU., KrettekC., ItoK.. Infection resistance of unreamed solid, hollow slotted and cannulated intramedullary nails: an in-vivo experimental comparison.J Orthop Res2005; 23: 810–15.
32.
MelcherG.A., MetzdorfA., SchlegelU.. Influence of reaming versus nonreaming in intramedullary nailing on local infection rate: experimental investigation in rabbits.J Trauma1995; 39: 1123–8.
33.
HaukeC., SchlegelU., MelcherG.A.. Local infection in relation to different implant materials. An experimental study using stainless steel and titanium, unlocked, intramedullary nailsin rabbits.Orthop Trans1997; 21: 835–6.
34.
ReedL.J., MuenchH.. A simple method of estimating fifty per cent end-points.Am J Hyg 193; 27: 493–497.
35.
CampocciaD., MontanaroL., MoriartyT.F., RichardsR.G., RavaioliS., ArciolaC.R.. The selection of appropriate bacterial strains in preclinical evaluation of infection-resistant biomaterials.Int J Artif Organs2008; 31: 841–7.
36.
HarrisL.G., RichardsR.G.. Staphylococci and implant surfaces: a review.Injury2006; 37(Suppl 2): S3–14.
37.
SchlegelU., PerrenS.M.. Surgical aspects of infection involving osteosynthesis implants: implant design and resistance to local infection.Injury2006; 37(Suppl 2): S67–73.
38.
GristinaA.G., HobgoodC.D., WebbL.X., MyrvikQ.N.. Adhesive colonization of biomaterials and antibiotic resistance.Biomaterials1987; 8: 423–6.
39.
AndersonJ.M., AshS.R., BayneN.R.. Handbook of biomaterials evaluation - Scientific, technical, and clinical testing of implant materials - 2nd ed.Philadelphia, PA: Taylor and Francis; 1999.
