Stimulation of fracture healing by continuous delivery of demineralized bone matrix proteins and tobramycin.
Demineralized bone matrix (DBM) is an allogenous, bioabsorbable material that has long been used for its osteoinductive and osteoconductive properties. A significant complication experienced by physicians who perform bone defect filling surgery is the risk of subsequent bacterial infections and the inefficiency of oral antibiotics to provide adequate prophylaxis against microorganisms, especially Staphylococcus aureus, Pseudomonas aeruginosa, and Staphylococcus epidermidis. In order to deliver both DBM and an efficient antiobiotic at high local concentrations without deleterious systemic effects, a ceramic sustained delivery system was implanted and monitored over the course of 30 days for bone regeneration, infection, and systemic effects. Twenty-five adult Sprague Dawley albino male rats were used in the experiment. They were randomly divided into five equal groups. Animals in group 1 were used as control, group 2 animals had a created 5mm defect, in group 3 defect induced and implanted with devices loaded with antibiotic (tobramycin) alone, group 4 had a created defect plus DBM, and group 5 had a created defect, plus tobramycin (which is effective against the aforementioned organisms) and DBM. At 30 days post-implantation, the experimental animals showed no significant difference in weight when compared to the control and sham animals. X-rays taken at this time showed the experimental femurs to be totally healed and virtually indistinguishable from control. Initial dissections revealed that the implants were accepted by the hosts as shown by the fibrous, vascularized sheath that surrounded the femurs and capsules. The implants were found to be in close contact with the cancellous bone and none of the sheaths showed signs of infection. Macroscopically, no defect could be detected in the experimental animals, while little regeneration was observed in the femurs of the sham animals.
Galjour
Chris
C
University of Mississippi Medical Center, Jackson, MS 39216, USA.
Dzugan
Sergey
S
Graves
Matt
M
Benghuzzi
Ham
H
Russell
George
G
Tucci
Michelle
M
Tsao
Audrey
A
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D018775:Bone Demineralization Technique / Q000379:methods; D001857:Bone Matrix; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage*; D004338:Drug Combinations; D004343:Drug Implants / Q000008:administration & dosage; D005264:Femoral Fractures / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D017102:Fracture Healing / Q000187:drug effects*; D008297:Male; D010000:Osteitis / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control*; D010012:Osteogenesis / Q000187:drug effects; D051381:Rats; D017207:Rats, Sprague-Dawley; D014031:Tobramycin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D019485:Bone Morphogenetic Proteins; D004338:Drug Combinations; D004343:Drug Implants; D014031:Tobramycin