title: Silver ion doped ceramic nano-powder coated nails prevent infection in open fractures: In vivo study.
abstract: BACKGROUND
  Despite improvement in operative techniques and antibiotic therapy, septic complications still occur in open fractures. We developed silver ion containing ceramic nano powder for implant coating to provide not only biocompatibility but also antibacterial activity to the orthopaedic implants.
  
  
  OBJECTIVE
  We hypothesised silver ion doped calcium phosphate based ceramic nano-powder coated titanium nails may prevents bacterial colonisation and infection in open fractures as compared with uncoated nails.
  
  
  METHODS
  33 rabbits divided into three groups. In the first group uncoated, in the second group hydroxyapatite coated, and in the third group silver doped hydroxyapatite coated titanium nails were inserted left femurs of animals from knee regions with retrograde fashion. Before implantation of nails 50 μl solution containing 10(6)CFU/ml methicillin resistance Staphylococcus aureus (MRSA) injected intramedullary canal. Rabbits were monitored for 10 weeks. Blood was taken from rabbits before surgery and on 2nd, 6th and 10th weeks. Blood was analysed for biochemical parameters, blood count, C-reactive protein and silver levels. At the end of the 10 weeks animals were sacrificed and rods were extracted in a sterile fashion. Swab cultures were taken from intramedullary canal. Bacteria on titanium rods were counted. Liver, heart, spleen, kidney and central nervous tissues samples were taken for determining silver levels. Histopathological evaluation of bone surrounding implants was also performed.
  
  
  RESULTS
  No significant difference was detected between the groups from hematologic, biochemical, and toxicological aspect. Microbiological results showed that less bacterial growth was detected with the use of silver doped ceramic coated implants compared to the other two groups (p=0.003). Accumulation of silver was not detected. No cellular inflammation was observed around the silver coated prostheses. No toxic effect of silver on bone cells was seen.
  
  
  CONCLUSIONS
  Silver ion doped calcium phosphate based ceramic nano powder coating to orthopaedic implants may prevents bacterial colonisation and infection in open fractures compared with those for implants without any coating.
authors.affiliation: Eskisehir Osmangazi University, Medical Faculty, Department of Orthopedics and Traumatology, Eskisehir, Turkey. Electronic address: drnkose@gmail.com.
authors.forename: Nusret
authors.initials: N
authors.lastname: Kose
authors.affiliation: Eskisehir Osmangazi University, Medical Faculty, Department of Orthopedics and Traumatology, Eskisehir, Turkey. Electronic address: rcaylak@ogu.edu.tr.
authors.forename: Remzi
authors.initials: R
authors.lastname: Çaylak
authors.affiliation: Anadolu University, Department of Materials Science and Engineering, Eskisehir, Turkey. Electronic address: cpeksen@omu.edu.tr.
authors.forename: Ceren
authors.initials: C
authors.lastname: Pekşen
authors.affiliation: Eskisehir Osmangazi University, Medical Faculty, Department of Microbiology, Eskisehir, Turkey. Electronic address: akiremitci@ogu.edu.tr.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kiremitçi
authors.affiliation: Eskisehir Osmangazi University, Medical Faculty, Department of Histology, Eskisehir, Turkey. Electronic address: dburakoglu@ogu.edu.tr.
authors.forename: Dilek
authors.initials: D
authors.lastname: Burukoglu
authors.affiliation: Anadolu University, Department of Enviromental Engineering, Eskisehir, Turkey. Electronic address: askopara@anadolu.edu.tr.
authors.forename: Savaş
authors.initials: S
authors.lastname: Koparal
authors.affiliation: Anadolu University, Department of Materials Science and Engineering, Eskisehir, Turkey. Electronic address: adogan@anadolu.edu.tr.
authors.forename: Aydın
authors.initials: A
authors.lastname: Doğan
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001858:Bone Nails / Q000382:microbiology; D002130:Calcium Phosphates; D020099:Coated Materials, Biocompatible / Q000494:pharmacology*; D004195:Disease Models, Animal; D005597:Fractures, Open / Q000473:pathology*; D008297:Male; D008422:Materials Testing; D053768:Metal Nanoparticles / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D050997:Nanomedicine; D016459:Prosthesis-Related Infections / Q000473:pathology*; D011817:Rabbits; D012834:Silver; D013203:Staphylococcal Infections / Q000473:pathology*; D014025:Titanium
chemical_list: D000900:Anti-Bacterial Agents; D002130:Calcium Phosphates; D020099:Coated Materials, Biocompatible; D012834:Silver; C020243:calcium phosphate; D014025:Titanium
keywords: Bacterial colonisation; Calcium phosphate ceramic; Silver ion