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      Treatment of a compound calcaneus fracture Sanders IV with an external circular fixator and calcaneal osteotomy

      case-report

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          Abstract

          Compound Gustilo-type III intra-articular calcaneus fractures are challenging to treat. Anatomical reduction of the subtalar joint increases the chances of a better functional outcome and is traditionally achieved by an open reduction and plating. Conversely, ORIF is associated with a high risk of infection and even amputation. In our case study, we present the treatment of a Gustilo-type III intra-articular calcaneus fracture with a circular external fixator and a temporary antibiotic cement spacer for fracture reduction and stabilization. Active bio-glass was implanted to fill bone loss and to prevent infection. A closing-wedge calcaneal tuberosity osteotomy was used to facilitate wound closure. We paid special attention to reducing the posterior facet. The patient returned to work and full ambulation five months post-injury.

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          Recent Evidence on Bioactive Glass Antimicrobial and Antibiofilm Activity: A Mini-Review

          Lorenzo Drago, Marco Toscano, Marta Bottagisio (2018)
          Bone defects caused by trauma or pathological events are major clinical and socioeconomic burdens. Thus, the efforts of regenerative medicine have been focused on the development of non-biodegradable materials resembling bone features. Consequently, the use of bioactive glass as a promising alternative to inert graft materials has been proposed. Bioactive glass is a synthetic silica-based material with excellent mechanical properties able to bond to the host bone tissue. Indeed, when immersed in physiological fluids, bioactive glass reacts, developing an apatite layer on the granule’s surface, playing a key role in the osteogenesis process. Moreover, the contact of bioactive glass with biological fluids results in the increase of osmotic pressure and pH due to the leaching of ions from granules’ surface, thus making the surrounding environment hostile to microbial growth. The bioactive glass antimicrobial activity is effective against a wide selection of aerobic and anaerobic bacteria, either in planktonic or sessile forms. Furthermore, bioglass is able to reduce pathogens’ biofilm production. For the aforementioned reasons, the use of bioactive glass might be a promising solution for the reconstruction of bone defects, as well as for the treatment and eradication of bone infections, characterized by bone necrosis and destruction of the bone structure.
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            The effect of local antibiotic prophylaxis when treating open limb fractures

            M. Morgenstern, A. Vallejo, M McNally … (2018)
            Objectives As well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures. Methods A comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis. Results In total, eight studies which included 2738 patients were eligible for quantitative synthesis. The effect of antibiotic-loaded poly(methyl methacrylate) beads was investigated by six of these studies, and two studies evaluated the effect of local antibiotics applied without a carrier. Meta-analysis showed a significantly lower infection rate when local antibiotics were applied (4.6%; 91/1986) than in the control group receiving standard systemic prophylaxis alone (16.5%; 124/752) (p < 0.001) (odds ratio 0.30; 95% confidence interval 0.22 to 0.40). Conclusion This meta-analysis suggests a risk reduction in FRI of 11.9% if additional local antibiotics are given prophylactically for open limb fractures. However, due to limited quality, heterogeneity, and considerable risk of bias, the pooling of data from primary studies has to be interpreted with caution. Cite this article: M. Morgenstern, A. Vallejo, M. A. McNally, T. F. Moriarty, J. Y. Ferguson, S. Nijs, WJ. Metsemakers. Bone Joint Res 2018;7:447–456. The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1
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              Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach.

              Niels W L Schep, Tim Schepers, Manouk Backes … (2014)
              Post-operative wound infections (PWI) following calcaneal fracture surgery can lead to prolonged hospital stay and additional treatment with antibiotics, surgical debridement or implant removal. Our aim was to determine the incidence of superficial and deep PWI and to identify risk factors (RF). This study is a retrospective case series. All consecutive patients from 2000 to 2010 with a closed unilateral calcaneal fracture treated with open reduction and internal fixation (ORIF) by an extended lateral approach were included. Patient, fracture, trauma and peri-operative characteristics were collected, including RF such as smoking, diabetes mellitus, time to operation, pre-operative in- or outpatient management and wound closure technique. The primary end point was a PWI as defined by the US Centers for Disease Control and Prevention. A total of 191 patients were included of which 47 patients (24.6%) had a PWI; 21 (11.0%) and 26 (13.6%) patients had a superficial and deep wound infection, respectively. American Society of Anesthesiologists (ASA) classification higher than ASA 1 was associated with an increased risk. Placement of a closed suction drain at the end of surgery was associated with less PWI (35% vs 15%, p = 0.002). In this study, none of the previously reported RF were associated with an increased risk for PWI. ORIF of displaced calcaneal fractures is associated with a high rate of PWI of 25%. Factors that were associated with an increased risk were ASA classification other than 1 and absence of a closed suction drain placement. A closed suction drain may be a protective measure to avoid wound complications.
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                Author and article information

                Contributors
                Aharon Liberson
                Journal
                Journal ID (nlm-ta): Trauma Case Rep
                Journal ID (iso-abbrev): Trauma Case Rep
                Title: Trauma Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-6440
                Publication date PMC-release: 20 May 2023
                Publication date Collection: August 2023
                Publication date (Electronic): 20 May 2023
                Volume: 46
                Electronic Location Identifier: 100850
                Affiliations
                [a ]Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
                [b ]Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
                Author notes
                [* ]Corresponding author. doc.aharon@ 123456gmail.com
                Article
                Publisher Item ID: S2352-6440(23)00098-5 Publisher ID: 100850
                DOI: 10.1016/j.tcr.2023.100850
                PMC ID: 10272509
                SO-VID: d4aa1c4b-ddb0-4380-b4a3-863f92fa470c
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date accepted : 19 May 2023
                Categories
                Subject: Case Report

                Keywords: calcaneal fracture,external fixation,ilizarov technique,compound
                Data availability:
                Keywords: calcaneal fracture, external fixation, ilizarov technique, compound

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