Fracture-related infection (FRI) remains one of the most challenging complications in orthopedic and musculoskeletal trauma surgery. FRI has been convincingly shown to delay healing, worsen functional outcome, and incur significant socio-economic costs. To address this clinical problem, ever more sophisticated technologies targeting the prevention and/or treatment of FRI are being developed and tested in vitro and in vivo.
In order to address the specific challenges of FRI, it is important to understand that these infections often involve complex fractures, open wounds, and significant soft tissue damage. Furthermore, these infections are known to involve biofilm formation and are increasingly caused by antibiotic resistant pathogens. New anti-infective strategies targeting FRI should ideally recognize all these factors in the design and testing phase.
Antibiotic delivery directly to the surgical site offers advantages over systemic application, particularly in patients with vascular damage. AO Research Institute Davos has developed and tested a range of local antibiotic delivery vehicles. One in-house development, in collaboration with the polymer focus area and preclinical testing facility, is an antibiotic-loaded thermo-responsive hyaluronic acid-based hydrogel. By developing a flowing delivery vehicle, we can apply antibiotic throughout even the most complex wounds. Anti-biofilm activity was confirmed in vitro and efficacy has been proven in both prophylactic and therapeutic preclinical in vivo models.