title: Poly(D,L-lactide) coating is capable of enhancing osseous integration of Schanz screws in the absence of infection.
abstract: Pin loosening is a major complication in external fixation. Biological and mechanical conditions play an important role in the maintenance and enhancement of the implant-bone interface in fracture fixation. It is thought that biodegradable coatings may be capable of preventing pin track infection and pin loosening. The goal of this study was therefore to analyze the influence of a biodegradeable coating on the osseous integration of Schanz' screws during fracture treatment. Standardized osteotomies (3-mm fracture gap) of the right tibiae were performed on 16 sheep and stabilized by an AO mono-lateral external fixator. Additional, mechanically less loaded Schanz' screws were also mounted. All screws were randomly coated with biodegradable poly(D,L-lactide). The sheep were sacrificed after 9 weeks. All screws were removed and rolled on blood agar plates for microbiological analysis. Histological sections of the pin tracks were histochemically and morphometrically analyzed. Clinically, no signs of severe infection were visible. Microbiological analysis revealed 14.8% colonization by Staphylococcus aureus in the coated and 29% in the uncoated screws. Histomorphometry of the bone surrounding the Schanz' screws revealed that significantly more osseous integration had occurred on poly(D,L-lactide)-coated screws in the absence of bacterial colonization. Significantly more bone remodeling and a higher osteoclastic activity was seen near the screw-bone interface in the uncoated screw group. Up to a threefold increase in new bone formation and more severe remodeling was observed around the screw entry compared to the pin exit in all groups. Loaded screws showed significantly more callus formation around the exit sites than their less loaded counterparts. In the present study, poly(D,L-lactide) coating of Schanz' screws was found to enhance osseous integration in the absence of bacterial colonization in sheep by causing less cortical remodeling and less osteoclastic activity in the cortices compared to uncoated screws. Additionally, the coating appeared to reduce the instances of pin track infections. Mechanical loading showed an adverse effect on bone formation and remodeling. It has been shown that both biological and mechanical factors play an important role in the maintenance of osseous integrity of the pin-bone interface. Poly(D,L-lactide) coating of Schanz' screws does not prevent osseous destruction and severe bacterial colonization along the pin tracts, but can improve osseous integration of Schanz' screws in the absence of infection.
authors.affiliation: Center for Musculoskeletral Surgery, Charité, University Medicine Berlin Free and Humboldt-University of Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Partale
authors.forename: P
authors.initials: P
authors.lastname: Klein
authors.forename: H
authors.initials: H
authors.lastname: Schell
authors.forename: G
authors.initials: G
authors.lastname: Schmidmaier
authors.forename: B
authors.initials: B
authors.lastname: Wildemann
authors.forename: H
authors.initials: H
authors.lastname: Bail
authors.forename: R
authors.initials: R
authors.lastname: Schiller
authors.forename: H
authors.initials: H
authors.lastname: Bragulla
authors.forename: G N
authors.initials: GN
authors.lastname: Duda
mesh_terms: D000362:Agar / Q000737:chemistry; D000818:Animals; D001863:Bone Screws; D020099:Coated Materials, Biocompatible; D016267:External Fixators; D005592:Fracture Fixation / Q000295:instrumentation*; D007249:Inflammation; D020366:Methylmethacrylate / Q000737:chemistry; D016348:Osseointegration; D010010:Osteoclasts / Q000378:metabolism; D010027:Osteotomy; D011091:Polyesters / Q000737:chemistry*; D012756:Sheep; D013211:Staphylococcus aureus / Q000378:metabolism; D013997:Time Factors
chemical_list: D020099:Coated Materials, Biocompatible; D011091:Polyesters; D020366:Methylmethacrylate; C033616:poly(lactide); D000362:Agar