title: [Susceptibility to infections and behavior of stainless steel : Comparison with titanium implants in traumatology].
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Haubruck
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland. gerhard.schmidmaier@med.uni-heidelberg.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schmidmaier
mesh_terms: D015897:Comorbidity; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015995:Prevalence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D013232:Steel; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D013232:Steel; D014025:Titanium
keywords: Implant coating; Implant related infection; Infection prophylaxis; Periosteal perfusion; Soft tissue trauma