Dynamic Compression Plate Research Articles

A Preliminary Study of Fabrication Technology for Dynamic Compression Plates Using Centrifugal Casting Process

The high cost of health services in low-income countries has caused them to produce implants and medical devices at low cost. This research highlights a preliminary study of the design concept, mould design, and fabrication of horizontal type centrifugal casting machines for the manufacture of dynamic compression plates materials. Normally, dynamic compression plate is produced from materials such as 316L stainless steel, cobalt, and titanium alloys. In this work, aluminium-silicon alloy was used in this preliminary study. Aluminium-silicon alloy was melted at a temperature of 730 °C and poured into a mould with a rotational speed of 1500 rpm. Tensile, hardness and microstructure investigation were carried out to discern the mechanical properties of the cast product from the horizontal type centrifugal casting machine. Results showed the measured value of tensile strength is not significantly different in the two zones of cast pipe, the butt zone of fall of molten metal (specimen A) was 147 MPa, and the butt-end zone (specimen B) was 142 MPa. The hardness value for the as-cast pipe obtained from the outside, middle, and inside, was 104.0, 92.9, and 80.3 HV, respectively. Evaluation of microporosity in fractures (from tensile test) results from horizontal type centrifugal castings showed a small distribution. Meanwhile, the calculation of the contour hole processing time for DCP with eight holes is 38 minutes per implant.

Lateral migration resistance of screw is essential in evaluating bone screw stability of plate fixation

Conventional evaluation of the stability of bone screws focuses on pullout strength, while neglecting lateral migration resistance. We measured pullout strength and lateral migration resistance of bone screws and determined how these characteristics relate to screw stability of locking plate (LP) and dynamic compression plate (DCP) fixation. Pullout strength and lateral migration resistance of individual bone screws with buttress, square, and triangular thread designs were evaluated in polyurethane foam blocks. The screw types with superior performance in each of these characteristics were selected. LP and DCP fixations were constructed using the selected screws and tested under cyclic craniocaudal and torsional loadings. Subsequently, the association between individual screws’ biomechanical characteristics and fixation stability when applied to plates was established. Screws with triangular threads had superior pullout strength, while screws with square threads demonstrated the highest lateral migration resistance; they were selected for LP and DCP fixations. LPs with square-threaded screws required a larger force and more cycles to trigger the same amount of displacement under both craniocaudal and torsional loadings. Screws with triangular and square threads showed no difference in DCP fixation stability under craniocaudal loading. However, under torsional loading, DCP fixation with triangular-threaded screws demonstrated superior fixation stability. Lateral migration resistance is the primary contributor to locking screw fixation stability when applied to an LP in resisting both craniocaudal and torsional loading. For compression screws applied to a DCP, lateral migration resistance and pullout strength work together to resist craniocaudal loading, while pullout strength is the primary contributor to the ability to resist torsional loading.

A biography of the point contact fixator (PC-Fix).

Starting in the mid-eighties, the AO (from the German "Arbeitsgemeinschaft für Osteosynthesefragen") Research Institute (ARI), Davos, Switzerland together with the commercial partners of the AO Foundation embarked on a decade-long project to design, develop, test in experimental animals and human clinical trials as well as bring to clinical use a new system for surgical osteosynthesis. The new plating system, what became known as the Point Contact Fixator (PC-Fix), addressed the shortcomings of the conventional plating by Dynamic Compression Plate (DCP) discovered either by careful examination of the clinical complications or by chance observation and informed inquiry in experimental animals. The focus was on avoiding iatrogenic damage to bone vascularisation caused by the implant design and mechanical function and, thus, aiding efforts of surgeons to preserve vital bone tissue needed for healing. Infections have been and will remain a great concern in all surgery. Preservation of blood perfusion of traumatised bone is of paramount importance to reduce the risk of infection, especially in view of the emergence and the accelerated spread of bacterial resistance to antibiotics. Prof. Stephan Perren led this project in all its stages with his unique insight and wisdom. Unfortunately, due to the complex interplay of factors guiding the interests of the AO Foundation and its commercial partners, the findings of the PC-Fix project became watered down with implant systems that followed the DCP. The message of "keep the perfusion" faded into "lock the screws". The potential benefits of PC-Fix have been lost for millions of trauma patients.

Successful utilization of triphasic silica containing ceramic coated hydroxyapatite (HASi) for the treatment of comminuted tibial fracture in a goat: a case report

A one year old female Sirohi crossbred goat was presented with a history of non weight bearing lameness on right hind limb. Radiography revealed comminuted fracture of tibial mid diaphysis. The comminuted fracture fragments and bone devoid of any soft tissue were surgically removed and the resultant segmental defect was reinstated with triphasic silica containing ceramic coated hydroxyapatite (HASi) after stabilising the fracture fragments with 2.7mm dynamic compression plate and screws. The animal recovered with normal limb ambulation after the eighth post-operative week.

Efficacy of a plasma-deposited, vancomycin/chitosan antibiotic coating for orthopaedic devices in a bacterially challenged rabbit model

This study investigated the efficacy of co-deposited vancomycin/chitosan coatings prepared using a plasma process on metallic implants in a bacterially challenged rabbit model. A BioDepTM plasma coating process was used to deposit thin layers of chitosan with vancomycin onto titanium alloy surfaces. Coated implants were examined using standard microscopy, profilometry and elution studies. Nitrided titanium alloy Ti-6Al-4V (Ti alloy) dynamic compression plates (DCP) (n=45) were implanted onto rabbit femurs and then challenged with a bacterial inoculum prior to closure. Three treatment groups were compared: an unmodified Ti alloy DCP that was considered the control, a DCP with the antibacterial coating of chitosan with vancomycin, and a DCP first blasted with alumina grit followed by a coating of chitosan with vancomycin. Bone, surrounding soft tissue, and implants were harvested after 28 days for bacterial quantification. The thin coating of chitosan and vancomycin was clearly detected on the implant surfaces after the plasma coating process. This coating eluted antimicrobial agents and prevented bacterial adhesion, regardless of surface roughness, and prevented biofilm formation compared to the control Ti alloy DCP. The blasting of the Ti alloy implant surface with alumina grit resulted in both roughening and partial implantation of the alumina particles, but did not alter the short-term antimicrobial effects of the chitosan/vancomycin coating. This study suggests that the plasma process is capable of depositing an antimicrobial agent directly onto the surface of metallic implants and that this vancomycin/chitosan coating may prove to be a useful pathway to prevent short-term biofilm formation.

A prospective randomised control study on dynamic compression plating versus intra medullary interlocking nailing in humeral diaphyseal fractures

<p class="abstract"><strong>Background:</strong> Surgical fixation of humeral shaft fractures generally involves plating or nailing. Despite the extensive literature comparing outcomes after open reduction with internal fixation (ORIF) with plating and interlocking intramedullary nailing (ILIMN) for acute humeral diaphyseal fractures, the superior treatment strategy still remains controversial. The purpose of this study was to compare the functional outcome of each method of fixation (dynamic compression plating and interlocking nailing) for the shaft of humerus fracture and to analyse statistically significant difference in the results of these two methods in terms of functional outcome, rate of healing and complications.</p><p class="abstract"><strong>Methods:</strong> We conducted a prospective randomized control study and evaluated the results of 50 patients having humeral shaft fracture which were internally fixed with antegrade interlocking nailing (25 patients) and dynamic compression plating (DCP) plate (25 patients). Patients were followed up on average of 11.4 months and their radiological outcomes were assessed with plain radiography and with DASH score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The plating group had statistically significant faster radiological healing and better DASH score compared to nailing group. Also, postoperative complication rate was higher in ILN group which was statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> ORIF with DCP provides better results in terms of good functional outcome, faster radiological union and less post-operative complications compared to ILIM nailing. Hence, we concluded that plating is a superior option than nailing.</p>

Comparative study of functional outcome of dynamic compression plating and interlocking nailing for fracture shaft of humerus in adults

Introduction: Fractures of humeral shaft are commonly encountered by an orthopaedic surgeon, accounting for 1-2% of all fractures. Treatment of these injuries continues to evolve as advances are made both in operative and non-operative management. Most humerus fractures are managed non operatively with anticipated good to excellent results. Surgery is indicated in certain settings, nature of injury, fracture pattern and also patient’s demand. Objective: The aim of this study is to compare the functional outcomes of plating with nailing and also the results of this study with standard works reported in literature, in terms of rate of union in both fixations, the functional outcomes of the treatment and incidence of complications like non-union, infection, radial nerve palsy. Setting: This study was conducted at the orthopedics department of a teaching hospital in India. Design: This was 2 years prospective, longitudinal, hospital based, observational study, and its outcomes. Participants: The study was done in 30 patients diagnosed as fractures of shaft of humerus of traumatic etiology meeting the inclusion & exclusion criteria, admitted at Mahatma Gandhi Memorial Hospital (attached to Kakatiya Medical College,Warangal), from December 2016 to November 2018.These patients were randomized into two groups in which 15 cases were treated by open reduction and internal fixation using the dynamic compression plate (DCP) and 15 cases were treated with closed reduction and internal fixation with intramedullary interlocking nail (ILN). Results: A detailed analysis of the functional outcome of 30 patients treated in the present study was done based on Rommen’s criteria, and out of 15 patients treated with dynamic compression plating,13 had excellent results, 2 had good results. In 15 patients treated with intramedullary interlocking nailing, 10 had excellent re sults and 3 had good results and 2 had poor result. Conclusion: Based on our experience and results

COMPARATIVE STUDY BETWEEN THE DYNAMIC COMPRESSION PLATING (DCP) AND THE INTRAMEDULLARY INTERLOCKING NAILING IN DIAPHYSEAL FRACTURES OF THE HUMERUS IN ADULTS

AIMS: The aim of our study was to nd the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From May 2019 to October 2019, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the “Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire”. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically signicant (P= 0.010). The complication associated with interlocking group was more than the DCP group. We are of the opinion that when surgery is opted as a choic CONCLUSION: e of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint.

A comparative study of distal third radius and ulna fractures treated with locking plate and non-locking plate in geriatric age group

Background: Fractures of radius and ulna are amongst the leading injuries in upper extremity in geriatric age group. Associated rotational instability of forearm bones in such fractures renders them suitable for operative fixation. Non-the less conservative management has also been employed in such injuries. We conducted this study to analyze and compare the outcomes of using Locking plate and Non-locking plates for internal fixation in geriatric population for distal 1/3rd shaft radius and ulna fractures in terms of fracture union, range of motion and functional outcome.Methods: Aprospective study of 20 patients with distal third radius and ulna fracture was conducted with 10 patients managed with locking 3.5 mm Dynamic Compression Plate and 10 with non-locking 3.5 mm Dynamic Compression Plate. All patients with extra-articular fractures were selected for this study and were randomly chosen for each procedure. They were followed up regularly at 3 weeks, 6 weeks and 12 weeks for time of union, wrist flexion, elbow flexion, supination, pronation and functional outcome.Results: There were a total of 13 males and 7 females. Mean time for radiological union was 5.8 weeks for Locking plate, 8 weeks for non-locking plate. Mean Flexion/Extension at elbow was 134o/140o for locking plate, 132o/139o for non-locking plate. Average supination/pronation was 61o/66.4o for locking plate, 57o/61.8o for non-locking plate. Mean duration for surgery was 75.25 minutes for locking plate, 75.70 minutes for non-locking plate.Conclusion: Open reduction and internal fixation with locking plating can be considered as the treatment of choice when considering fixation of distal third Radius and Ulna fractures in geriatric age group.

Minimally invasive plate osteosynthesis for humerus diaphyseal fractures: A retrospective study

Introduction: Several authors have reported anterior bridge plating of humerus as an acceptable and satisfactory procedure for treatment for humerus shaft fractures.We evaluated the clinical, radiological and functional outcome of such fractures over a period of follow up of 12 months treated by MIPO technique.Materials and Methods: Twenty patients presenting to author institute on follow up with humerus shaft fractures treated with anterior bridge plating using MIPO technique between January 2015 – December 2018. In all cases 4.5 mm dynamic compression plate (DCP) was used. The surgery time, radiation exposure and time for union was noted using hospital records. The shoulder and elbow function was assessed using UCLA (The University Of California At Los Angeles)shoulder and Mayo elbow performance score respectively.Results: Out of the 20 patients, 14 were male and 6 females. The mean age was 38.2 years (range 20 to 68).14 out of 20 patients (70%) had dominant side fractured.Mean surgical time was 82.7 minutes (range 60-120 minutes). Mean radiation exposure counted as one second for C- arm exposure was 112 seconds (80-170). The mean time for union was 13.4 weeks (range10 -20 weeks). Shoulder function was excellent in 17 patients (85%) and good in remaining 3 patients (15%) according to the UCLA score.elbow function was excellent in 15 cases (75%) and good in 5 cases (25%).Conclusion: Anterior bridge plating ofhumerusis an effective treatment for humerus shaft fractures and as the surgeon keep on gaining experience in this technique, it becomes less time consuming.

ADEQUACY OF THREE DIMENSIONAL MINIPLATE IN TREATMENT OF MANDIBULAR FRACTURE IN INTERFORAMINAL REGION

Background: Mandible is one of the commonly fractured bone due to trauma, assault and falls. Treatment includes closed and open methods. Methods of open reduction and internal fixation have changed and di­versified enormously in the past few years. Champy’s miniplate fixation, dynamic compression plating has become a standard approach. More recently, three dimensional miniplates have been developed by Farmand which may be effectively used in mandibular fractures. The aim of this study was to check the adequacy of three dimensional miniplate in man­agement of mandibular fracture occurring in the interforaminal region. 
 Methods: A prospective clinical study was carried out in patients attend­ing Emergency Department and Department of Oral and Maxillofacial Surgery, Nobel Medical College and Teaching Hospital (NMCTH) suffer­ing from mandibular fractures in interforaminal region from May 2018 to January 2019. 
 Results: A total of 17 patients with 18 fracture in interforaminal region, all male were included in the study. The age ranged from 16 to 50 years with a mean of 29.17 ± 9.48. Road traffic accident was the leading cause of injury with 15 out of 17 patients (88.23%). There was no incidence of wound infection, wound dehiscence, malunion, nonunion, plate fracture within the follow up period of 3 months. One fracture was unstable on 1st postoperative day and also had mildly deranged occlusion which was man­aged with intermaxillary fixation for two weeks. 
 Conclusions: Three dimensional plates fulfills the treatment goals of ad­equate stabilization and fixation of mandibular interforaminal fractures.

Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy

BackgroundParallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO.MethodsBetween June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated.ResultsThe baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy.ConclusionsThe minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.

β tricalcium phosphate as a bone substitute for fracture healing in goats

The study was conducted on twelve clinical cases of goats having long bone fracture, presented at Teaching Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Jabalpur, during the study period. In group I the fracture segment was immobilized by dynamic compression plate whereas, in group II after immobilization with dynamic compression plate gap at fracture site was filled with β tricalcium phosphate. There was a gradual decrease in exudates and pain at fracture site in both the groups from 2nd postoperative day onwards. A significant increase in weight bearing was observed from 7th post-operative day in both the groups of goat. Complete weight bearing by all the animals was observed on 30th day in group II. Radiographic examination on 15th post-operative day, depicted evidence of periosteal reaction on both the fracture segment, almost in all the cases of group II. Radiograph taken on 60th post-operative day, exhibited radiodense area at the fracture site, indicative of extensive periosteal and endosteal callus. The values of alkaline phosphatase increased non-significantly in both groups of goat up to 15th post-operative day. After reaching its maximum values, a decline in the values was observed in both the groups.

An experimental study on stress-shielding effects of locked compression plates in fixing intact dog femur

BackgroundIn orthopedic application, stress-shielding effects of implant materials cause bone loss, which often induces porosis, delayed bone healing, and other complications. We aimed to compare the stress-shielding effects of locked compression plate (LCP) and limited-contact dynamic compression plate (LC-DCP) in dogs with plate-fixed femurs.MethodsBilateral intact femurs of 24 adult dogs were fixed by adult forearm 9-hole titanium plates using minimally invasive plate osteosynthesis (MIPPO) technology, with LCP on the left and LC-DCP on the right femurs. Dogs were sacrificed at 6 weeks, 12 weeks, and 24 weeks after surgery, and bone specimens were used to evaluate the efficacies of different fixing methods on bones through X-ray, dual-energy X-ray absorptiometry (DEXA), histology, MicroCT, and biomechanics analyses.ResultsX-ray results showed significant callus formation and periosteal reaction in the LC-DCP group. Bone cell morphology, degree of osteoporosis, and bone mineral density (BMD) changes of the LCP group were significantly better than that of the LC-DCP group. MicroCT results showed that the LCP group had significantly reduced degree of cortical bone osteoporosis than the LC-DCP group. Tissue mineral density (TMD) in the LCP group was higher than that in the LC-DCP group at different time points (6 weeks, 12 weeks, and 24 weeks). Biomechanics analyses demonstrated that the compressive strength and flexural strength of bones fixed by LCP were better than that by LC-DCP.ConclusionsStress-shielding effects of LCP are significantly weaker than that of LC-DCP, which is beneficial to new bone formation and fracture healing, and LCP can be widely used in clinic for fracture fixation.

The \u201cfloating ulna\u201d injury in adults: a case report, literature review and proposed injury classification

BackgroundIpsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern. A few reports have described this type of injury and its treatment.Case presentationA 33-year-old female at 38+ weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. At the 12-month follow-up, the patient had no pain or signs of instability. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm.ConclusionThe “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma.

Functional outcome of diaphyseal fractures of both bones of forearm in adults after fixation with dynamic compression plate at a tertiary care center

Functional outcome of diaphyseal fractures of both bones of forearm in adults after fixation with dynamic compression plate at a tertiary care center

Management of fracture both bones forearm with plating/medullary nailing: A comparative study

Introduction: Fracture of both bones forearm in adults occupy a large field of modern traumatology. Maintenance of radial bow, regaining length, good apposition and alignment without malrotation is essential to restore good range of motion of forearm. Aim: to compare functional and radiographic results of plate osteosynthesis to IM nailing in treatment of diaphyseal forearm fracture in adults.Method: A prospective study comprising of 32 patients. 16 patients treated with open reduction and internal fixation using 3.5 mm DCP and 16 patients by IM nailing using 316L SS Talwarkar square nailing by closed or mini open reduction.Result: Mean age of patients was 36.4 years (range 20 to 58 years), Maximum number of patients in this study are middle age group and mean age is 48 years most fractures were of type 22A3 as per AO/OTA classification. Average operative time was 83 minutes and 64 minutes in plating and nailing respectively. Out of 16 patients in each group in our present study we encountered complications like restriction of movements at elbow in 5 (31.25%) plating cases and 3 (18.75%) nailing cases; restriction of movements at wrist in 1(6.25%) plating case and 0 nailing cases and loss of supination or pronation or both were observed in 6 (37.5%) each in nailing and plating cases. Localised bursitis were observed in 2 (12.5) nailing cases alone & wound healing and superficial infections were observed in 2 (6.25%) plating cases alone. We had 1 (6.25%) Non-Union is case of Plating and all fractures united in cases operated with nailing. Out of the 32 sample cases, taking into the account of our functional grading we have observed that about 9 (56.25%) cases have been graded with excellent outcome in plating group and 10 (62.5%) in nailing group, similarly about 5 (31.25%) have been graded with good outcome in plating and 3 (18.75%) in nailing group respectively and satisfactory outcome in 1 (6.25%) in plating group and 3 (18.75%) in nailing group. This has been only 1 (6.25%) case which had a Poor outcome in plating group in our study.Conclusion: We conclude that open reduction and internal fixation with dynamic compression plating is gold standard for treating diaphyseal forearm fracture in adults as it provides rigid fixation, restores forearm stability earlier and has negligible complications.

Studies on the efficacy of stem cells for fracture healing in goats

The study was conducted on twelve clinical cases of goats having long bone fracture randomly divided into two groups. In group I the fracture segment was immobilized by dynamic compression plate whereas, in group II after immobilization with dynamic compression plate mesenchymal stem cells were transplanted at fracture site. Exudates and pain at fracture site revealed a decreasing trend in both the groups from 7th to 15th post - operative day. A significant increase in weight bearing was observed from 7th post-operative day in both the groups of goat. Radiographic interpretation at different interval revealed early periosteal reaction, formation of soft and hard callus and initiation of remodeling in group II as compared to group I, The values of alkaline phosphatase increased non-significantly in all groups of goat up to 15th post-operative day, with maximum value at this interval. After reaching its maximum values, a decline in the values was observed in both the groups.

Proximal interphalangeal arthrodesis in seven horses: A retrospective study in Brazil (2011-2019)

ABSTRACT: This study discussed several cases of proximal interphalangeal arthrodesis in horses at a veterinary hospital in Brazil. The medical records of seven horses that underwent proximal interphalangeal arthrodesis between 2011 and 2019 were analyzed for indication, technique, and complications. Short- and long-term outcomes were obtained from both the medical records and telephone interviews with the owners. A dynamic compression plate (DCP) was used in one of the seven horses that underwent surgical arthrodesis, and locking compression plates (LCP) were used in the others. Hospital discharge was recorded in 71.4% (5/7) of the horses, with an average hospital stay of 79 ± 45 days. Casting was maintained for 59 ± 26 days. Contact with owners was possible in four cases, two of which regained their prior level of function. The proximal interphalangeal arthrodesis may improve a horse’s well-being, especially when it is considered an early intervention, minimizing the chances of immediate postoperative complications. Additional cases of surgical arthrodesis should be evaluated in long term to better characterize the outcomes of this procedure in Brazil.

Microbiological Profile of Orthopaedic Implant Associated Infections: A Prospective Study

Introduction: The incidence of orthopaedic implantation and implantation associated infections were correspondingly increasing among the elderly and trauma patients. The resistance among the pathogens pose a unique challenge to the clinicians in the management of the infection. Extended-Spectrum Beta-Lactamase (ESBL), AmpC beta-lactamases (AmpC), Metallo Beta-Lactamases (MBL) and Methicillin-Resistant Staphylococcus aureus (MRSA) producing bacterial pathogens are responsible for a high rate of relapsing infections and outbreaks of nosocomial infections. Aim: To focus on accounting the incidence of ESBL, AmpC, MBL and MRSA and its antibiogram for effective management of implant associated infection. Materials and Methods: The present study was a prospective observational study which was conducted using various samples like pus, wound swab, serous discharge. These samples were collected under aseptic precautions in sterile containers for the period of one year (February 2015-February 2016). A total of 200 samples were inoculated on Blood agar and McConkey agar and identified. The isolates were tested for detection of ESBL, AmpC, MBL and MRSA as per standard protocol. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 20.0 Chicago, USA. Results: Most commonly used implants were intramedullary interlocking nail 138 (65.7%) followed by dynamic compression plates 23 (11.0%) and anatomical plates 18 (8.6%). Of the total of 200 samples, 190 (95%) samples yielded monomicrobial isolates and 10 (5%) samples yielded polymicrobial isolate. gram negative isolates 108 (51.4%) were marginally higher than gram positive isolates 102 (48.6%). The predominant isolate was S. aureus 81 (38.5%) followed by Klebsiella spp. 28 (13.3%) and Pseudomonas aeruginosa 21 (10.0%). In gram negative isolates, 76 (70.4%) were ESBL and/or AmpC producers. Of which, 48 (44.4%) were ESBL and AmpC co-producers. There were no MBL producing isolates. In gram positive isolates, majority were S. aureus 81 (79.4%) followed by Coagulase-negative Staphylococcus 21 (20.6%). Out of 81 S. aureus isolates, 46 (56.8%) were MRSA. Out of 21 CoNS, majority 17 (81%) isolates were methicillin-resistant. Implant failures were observed in 28 (14%) cases. Out of 28, majority 12 (42.8%) of the implant failures were MRSA. Conclusion: High rates of ESBL, AmpC and MRSA infections associated with implant surgeries indicate the necessity to formulate antibiotic policies and control measures. ESBL and AmpC producing strains were found to show higher rates of resistance to the various class of antibiotics when compared to non-ESBL and non-AmpC producers. MRSA isolates were found to show higher rates of resistance to various classes of antibiotics when compared to MSSA