Christopher T. Born

With the rise in antibiotic resistance, new methodologies are needed to combat musculoskeletal infections. Silver is an antimicrobial that can be synthesized in different forms, but its pharmacokinetics are difficult to control. This study details the antibacterial efficacy and cellular cytotoxicity of a formulation consisting of silver carboxylate (AgCar) released through a titanium dioxide/polydimethylsiloxane matrix with a predictable release profile on Pseudomonas aeruginosa, Acinetobacterium baumannii, and human-derived primary osteoblasts. Through an Institutional Animal Care and Use Committee and IRB-approved protocol, AgCar was applied to live Yucatan porcine skin and histologically analyzed for skin penetration. Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) was used to measure elution of AgCar. Dose–response curves were generated through optical density to assess potency. Finally, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to quantify the cellular cytotoxicity of the novel formulation. The results were subject to statistical analysis using analysis of variance and post hoc Tukey tests. The silver carboxylate coating demonstrated deep penetration into the epithelium at the level of the deep pilosebaceous glands in animal models. GFAAS testing demonstrated the extended elution profile of silver carboxylate over 96 hours, while 100% silver with no titanium dioxide-polydimethylsiloxane matrix fully eluted within 48 hours. 10x silver carboxylate demonstrated superior antimicrobial activity to antibiotics and other silver formulations and showed minimal cytotoxicity compared with other silver formulations. Current antimicrobial therapies in wound care and surgical antisepsis, such as chlorhexidine gluconate, have pitfalls including poor skin penetration and short duration of efficacy. The broad antimicrobial activity, extended elution, and deep skin penetration of this AgCar formulation show great promise for surgical site infection and wound care treatment. Novel technology to fight the growing threat of microbial resistance should be at the forefront of orthopaedic surgical site infection prevention and treatment.

Introduction: One of the leading issues facing persons with amputation is late development of antibiotic-resistant bacterial infections of the residual limb. To reduce this infection risk, this study assessed the antimicrobial properties and profile of a silver carboxylate complex coating applied to samples of common prosthetic liner materials against pathogens frequently encountered in amputation-site infections. Methods: The antimicrobial efficacy of the coating was measured utilizing a Kirby-Bauer assay with two different types of commercially available prosthetic liners. The assay was run against four pathogens including coagulase-negative Staphylococcus epidermidis, methicillin-sensitive Staphylococcus aureus, Enterococcus faecalis, and multidrug-resistant Acinetobacter baumannii. Observations of bacterial inhibition were made at 24-, 48-, and 72-hr time points for all four pathogens. Dose response curves were created to assess the relative efficacy of the coating against each pathogen independent of prosthetic liners. Graphite furnace atomic absorption spectroscopy (GFAAS) was utilized to measure coating silver elution at 24-, 48-, and 72-hr time points. Results: All conditions of the coating were variably antimicrobial against all tested pathogens in the Kirby-Bauer analysis. Dose response analysis further demonstrated the coating's antimicrobial profile against all tested pathogens. GFAAS demonstrated consistent silver release of the coating throughout 72 hrs. Conclusions: The results of this study suggest the tested antimicrobial coating is effective against a broad range of drug-resistant pathogens. Due to its ability to reduce and inhibit bacterial growth along the prosthetic liner surface, the coating shows promise as an effective tool toward mitigating infection and malodor found at the residual limb-liner interface among persons with amputation.

Study design A microscopy-based investigation of the permissive factors leading towards bacterial adherence on commonly utilized spinal implants. Objective The adherence and subsequent colonization and biofilm formation of bacteria on orthopaedic implants represents one of the most serious problems facing orthopaedic surgeons. Once a biofilm is formed, surgeons may have to resort to implant removal, a strategy that may cause substantial patient morbidity and lead to additional cost to the healthcare system. This problem has been further compounded by the rise of antibiotic-resistant strains of bacterial pathogens. In this study, two commonly encountered bacterial pathogens in surgical site infections (SSI) were characterized for adherence pattern, density, and propagation on five commonly used spinal implant materials via scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Summary of background data The results show that bacterial adherence is largely dependent on the microtopographical features observed on the surface of the materials tested. Methods Five commonly utilized spinal implant materials were inoculated with two of the most common nosocomial pathogens and visualized via scanning electron microscopy and confocal laser scanning microscopy. Results Analysis of 90 spinal implant pieces showed that even though no material showed the ability to prevent adherence of both pathogens tested, the presence of surface imperfections and rougher microtopography was found to harbor the most bacterial presence. Conclusion Our data suggests that implants materials with uniform surface and minimal imperfections may reduce the ability of bacterial to adhere to implants. Level of evidence Level I evidence: “Investigation of a diagnostic test”.

Background: Normal skin microbiota influence susceptibility to surgical infections. The distribution of skin bacteria differs by anatomic site, and given the right conditions, almost any of these bacteria can become an opportunistic pathogen. Methods: This paper provides a thorough review of the most commonly encountered bacteria in various regions of the body and their isolation from operative incisions at those locations. These data may be useful in optimizing targeted antibiotic therapy for surgical site infections and provide a better understanding of the skin biome distribution at specific surgical sites. Conclusion: Typical skin-borne flora, surgical site infections, orthopedic infections by body part, and drug-resistant pathogens are reviewed.

This article discusses recent reports on distal radius fractures. The keyword "distal radius fracture" was used to query the PubMed database of the US National Library of Medicine. From the resulting list, articles published in the Journal of Hand Surgery (American Volume), the Journal of Hand Surgery (European Volume), and the Journal of Orthopaedic Trauma from April 2014 through December 2015 were reviewed. Related commentaries were also evaluated. Case series of fewer than 5 patients were excluded. The 65 studies and commentaries identified are categorized and summarized. [Orthopedics. 2017; 40(3):145-152.].

Motorcycle helmets reduce both motorcycle-related fatalities and head injuries. Motorcycle crashes are a major public health concern which place economic stress on the U.S. healthcare system. Although statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet. Herein, we propose and outline the solution of implementing federal motorcycle helmet law, while addressing potential counterarguments. The decision to ride a motorcycle without a helmet has consequences that affect more than just the motorcyclist. In an effort to prevent unnecessary healthcare costs, injuries, and deaths, public health efforts to increase helmet use through education and legislation should be strongly considered. Helmet use on motorcycles fits squarely within the purview of the federal government public health and economic considerations.

Er alert notification systems should be standardized and should be understood.➢Communication systems used in a disaster should have redundancy.➢A department’s response plan must be integrated into the overall hospital plan.➢Large casualty volumes require appropriate triage and resource allocation.➢Response provider emotional and health support is an important consideration....

We conducted a prospective study to evaluate the prevalence of cognitive impairment (CI) in elderly inpatients awaiting surgery for hip fracture, and to compare CI and normal cognition (NC) patients with respect to preoperative pain, fear, and anxiety. The study included patients who were older than 65 years when admitted to a hospital after acute hip fracture. Preoperative assessment involved use of Confusion Assessment Method-Short Form, Montreal Cognitive Assessment (MoCA), visual analog scales for anxiety and fear, and Wong-Baker Faces Pain Scale. Patients with delirium were excluded from the study. Patients with CI and NC, as determined by MoCA score, were compared for each assessment. Of the 65 hip fracture patients enrolled, 62 had evaluable cognitive data. Of these 62 patients, 23 (37.1%) had NC (MoCA score, ≥ 23) and 39 (62.9%) had CI (MoCA score, < 23). Only 5 (7.7%) of the 65 patients had a documented diagnosis of CI or dementia at time of hospitalization. Mean preoperative pain scores were significantly (P < .001) higher for CI patients (5.3) than for NC patients (2.8). Our study results showed that many elderly hip fracture patients had unrecognized CI before surgery, and CI patients had significantly more pain than NC patients did. Appropriate identification of preoperative CI and treatment of pain are crucial in optimizing patient outcomes.

Motorcycle-related head injuries and fatalities are a serious public health concern that can be reduced with helmet use. Caring for crash victims places additional economic stress on the healthcare system. The current Connecticut motorcycle helmet law does not require all motorcyclists to wear helmets. Universal motorcycle helmet laws increase helmet use. Efforts to increase helmet use through education and legislation should be considered for review, given the number of deaths and injuries that could be prevented.