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Infektanfälligkeit und Verhalten von Stahl

Vergleich mit Titanimplantaten in der Traumatologie

Susceptibility to infections and behavior of stainless steel

Comparison with titanium implants in traumatology

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Zusammenfassung

Hintergrund

Peri- und postoperative implantatassoziierte Infektionen (IAI) stellen schwerwiegende Komplikationen im Rahmen der osteosynthetischen Versorgung von Frakturen dar. Fast 30 Jahre nach dem Beginn der Verwendung von Titanimplantaten gibt es weiterhin keinen einheitlichen Konsens, ob Titanimplantate nachweislich einen relevanten klinischen Benefit für IAI-Patienten darstellen.

Fragestellung

Sind Titanimplantate im Vergleich zu herkömmlichen Edelstahlimplantaten resistenter bez. IAI?

Material und Methoden

Es wurde eine strukturierte Literaturrecherche bez. IAI im Kontext des verwendeten Implantatmaterials durchgeführt. Relevante Publikationen, welche zwischen 1995 und 2016 publiziert wurden, wurden in der PubMed-Datenbank eruiert. Insgesamt konnten 183 Publikationen in der PubMed-Datenbank identifiziert werden. Alle verfügbaren Abstracts wurden überprüft, dabei verblieben 14 relevante Publikationen. Die eingeschlossenen Studien wurden daraufhin bez. ihres Evidenzgrades stratifiziert und hinsichtlich ihrer Aussage zum Einfluss des verwendeten Implantatmaterials auf IAI evaluiert.

Ergebnisse und Diskussion

Die Ergebnisse dieses Reviews belegen, dass nach momentaner Studienlage ein Vorteil von Titanimplantaten in Hinsicht auf IAI nicht nachgewiesen werden kann. Lediglich dezente Tendenzen bez. geringerer Anfälligkeit für IAI bei Verwendung von Titanimplantaten existieren in der Literatur, jedoch ohne statistisch signifikanten Vorteil. Es stellte sich jedoch heraus, dass bei der Verwendung von Platten zur Osteosynthese Implantate, welche die periostale Durchblutung schonen und ein geringeres Weichteiltrauma auslösen, einen Vorteil hinsichtlich IAI unabhängig des Materials bieten.

Abstract

Background

Despite modern treatment options, implant-associated infections (IAI) remain a severe and challenging complication in the treatment of trauma patients. Almost 30 years after the introduction of implants made of titanium alloy into the treatment of trauma patients, there is still no uniform consensus regarding the clinical benefit of titanium alloy in the context of patients with IAI.

Objective

We sought to determine if implants made of titanium alloy have been proven to be less susceptible regarding IAI in contrast to implants made of stainless steel.

Material and methods

A review of the current literature on IAI in association with the utilized implant material was conducted. Relevant articles from the years 1995 to 2016 were searched in the PubMed database. A total of 183 articles were identified and all abstracts were reviewed for relevance. A total of 14 articles met the inclusion criteria and were stratified according to the level of evidence and furthermore evaluated regarding the influence of the implant material on IAI.

Results and discussion

Considerable debate remains concerning the influence of the implant material on the susceptibility to IAI; however, the available literature shows that despite slight tendencies, there is no proof of titanium alloy being favorable in the susceptibility to IAI. Furthermore, the literature shows that the design of plates for osteosynthesis might influence IAI. In particular, plates that cause less soft tissue damage and preserve perfusion of the periosteum proved to be beneficial regarding IAI.

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Literatur

  1. Arens S, Hansis M, Schlegel U et al (1996) Infection after open reduction and internal fixation with dynamic compression plates–clinical and experimental data. Injury 27(Suppl 3):SC27–SC33

    PubMed  Google Scholar 

  2. Dapunt U, Lehner B, Burckhardt I et al (2014) Evaluation of implant sonication as a diagnostic tool in implant-associated infections. J Appl Biomater Funct Mater 12:135–140

    PubMed  Google Scholar 

  3. Eijer H, Hauke C, Arens S et al (2001) PC-Fix and local infection resistance–influence of implant design on postoperative infection development, clinical and experimental results. Injury 32(Suppl 2):B38–B43

    Article  PubMed  Google Scholar 

  4. Fuchs T, Stange R, Schmidmaier G et al (2011) The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg 131:1419–1425

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ganser A, Thompson RE, Tami I et al (2007) An in vivo experimental comparison of stainless steel and titanium Schanz screws for external fixation. Eur J Trauma Emerg Surg 33:59–68

    Article  PubMed  Google Scholar 

  6. Harris LG, Meredith DO, Eschbach L et al (2007) Staphylococcus aureus adhesion to standard micro-rough and electropolished implant materials. J Mater Sci Mater Med 18:1151–1156

    Article  CAS  PubMed  Google Scholar 

  7. Harris LG, Richards RG (2006) Staphylococci and implant surfaces: a review. Injury 37(Suppl 2):S3–S14

    Article  PubMed  Google Scholar 

  8. Hudetz D, Ursic Hudetz S, Harris LG et al (2008) Weak effect of metal type and ica genes on staphylococcal infection of titanium and stainless steel implants. Clin Microbiol Infect 14:1135–1145

    Article  CAS  PubMed  Google Scholar 

  9. Johansson A, Lindgren JU, Nord CE et al (1999) Local plate infections in a rabbit model. Injury 30:587–590

    Article  CAS  PubMed  Google Scholar 

  10. Johansson A, Lindgren JU, Nord CE et al (1999) Material and design in haematogenous implant-associated infections in a rabbit model. Injury 30:651–657

    Article  CAS  PubMed  Google Scholar 

  11. Ktistakis I, Giannoudi M, Giannoudis PV (2014) Infection rates after open tibial fractures: are they decreasing? Injury 45:1025–1027

    Article  PubMed  Google Scholar 

  12. Lucke M, Schmidmaier G, Sadoni S et al (2003) Gentamicin coating of metallic implants reduces implant-related osteomyelitis in rats. Bone 32:521–531

    Article  CAS  PubMed  Google Scholar 

  13. Matter P, Burch HB (1990) Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system. Arch Orthop Trauma Surg 109:311–313

    Article  CAS  PubMed  Google Scholar 

  14. Metsemakers WJ, Kuehl R, Moriarty TF et al (2016) Infection after fracture fixation: Current surgical and microbiological concepts. Injury. doi:10.1016/j.injury.2016.09.019

    Google Scholar 

  15. Metsemakers WJ, Moriarty TF, Nijs S et al (2016) Influence of implant properties and local delivery systems on the outcome in operative fracture care. Injury 47:595–604

    Article  PubMed  Google Scholar 

  16. Metsemakers WJ, Schmid T, Zeiter S et al (2016) Titanium and steel fracture fixation plates with different surface topographies: Influence on infection rate in a rabbit fracture model. Injury 47:633–639

    Article  CAS  PubMed  Google Scholar 

  17. Moghaddam A, Graeser V, Westhauser F et al (2016) Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use? Ther Clin Risk Manag 12:1387–1393

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mohamed A, Rajeev AS (2016) Clinical outcomes and complications of titanium versus stainless steel elastic nail in management of paediatric femoral fractures-a systematic review. Eur J Orthop Surg Traumatol. doi:10.1007/s00590-016-1880-x

    PubMed  Google Scholar 

  19. Pieske O, Geleng P, Zaspel J et al (2008) Titanium alloy pins versus stainless steel pins in external fixation at the wrist: a randomized prospective study. J Trauma 64:1275–1280

    Article  CAS  PubMed  Google Scholar 

  20. Rochford ET, Richards RG, Moriarty TF (2012) Influence of material on the development of device-associated infections. Clin Microbiol Infect 18:1162–1167

    Article  CAS  PubMed  Google Scholar 

  21. Schlegel U, Perren SM (2006) Surgical aspects of infection involving osteosynthesis implants: implant design and resistance to local infection. Injury 37(Suppl 2):S67–S73

    Article  PubMed  Google Scholar 

  22. Schmidmaier G, Kerstan M, Schwabe P et al (2016) Clinical experiences in the use of a Gentamicin-coated titanium nail in open and closed fractures of the tibia. Injury (In press)

  23. Seligson D, Mehta S, Mishra AK et al (1997) In vivo study of stainless steel and Ti-13Nb-13Zr bone plates in a sheep model. Clin Orthop Relat Res 343:213–223

    Article  Google Scholar 

  24. Veerachamy S, Yarlagadda T, Manivasagam G et al (2014) Bacterial adherence and biofilm formation on medical implants: a review. Proc Inst Mech Eng H 228:1083–1099

    Article  PubMed  Google Scholar 

  25. Vester H, Wildemann B, Schmidmaier G et al (2010) Gentamycin delivered from a PDLLA coating of metallic implants: in vivo and in vitro characterisation for local prophylaxis of implant-related osteomyelitis. Injury 41:1053–1059

    Article  PubMed  Google Scholar 

  26. Voggenreiter G, Leiting S, Brauer H et al (2003) Immuno-inflammatory tissue reaction to stainless-steel and titanium plates used for internal fixation of long bones. Biomaterials 24:247–254

    Article  CAS  PubMed  Google Scholar 

  27. Weckbach S, Losacco JT, Hahnhaussen J et al (2012) Challenging the dogma on inferiority of stainless steel implants for fracture fixation. An end of the controversy? Unfallchirurg 115:75–79

    Article  CAS  PubMed  Google Scholar 

  28. Zimmerli W, Moser C (2012) Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol 65:158–168

    Article  CAS  PubMed  Google Scholar 

  29. Zimmerli W, Sendi P (2011) Pathogenesis of implant-associated infection: the role of the host. Semin Immunopathol 33:295–306

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    Patrick Haubruck &  Gerhard Schmidmaier

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  1. Patrick Haubruck
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  2. Gerhard Schmidmaier
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Correspondence to Gerhard Schmidmaier.

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Interessenkonflikt

P. Haubruck und G. Schmidmaier geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

D. G. Höntzsch, Tübingen

W. Mutschler, München

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Haubruck, P., Schmidmaier, G. Infektanfälligkeit und Verhalten von Stahl. Unfallchirurg 120, 110–115 (2017). https://doi.org/10.1007/s00113-016-0300-3

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