A guide frame for the Taylor Spatial Frame.

The Taylor Spatial Frame (TSF) is a versatile multiplanar external fixator that combines ease of application with computer accuracy to effectively reduce fractures and correct all aspects of deformity in reconstructive orthopaedic surgery. However, postapplication adjustments depend on adequate anteroposterior and lateral radiographic measurements to yield the most accurate output from the program. These radiographs need to be taken in an orthogonal plane to the reference ring. We describe a noninvasive technique using a specifically designed radiolucent frame that can be attached to the TSF to guide the surgeon and radiologist in obtaining lateral and anteroposterior radiographs, with the reference ring perfectly orthogonal in single exposures for each radiographic view. By using this guiding frame, reproducible and consistent x-rays oriented orthogonally to the reference ring at different points in the correction may be achieved, thus eliminating the need for repeat radiographs and radiation exposure for patients, radiologists, and surgeons. In this manner, the mounting parameters and the orientation of the bony deformity will be consistent. This should lead to enhanced accuracy of the TSF correction.

Treatment of experimental osteomyelitis by methicillin resistant Staphylococcus aureus with bone cement system releasing grepafloxacin.

The authors examined the effectiveness of the local anti-microbial treatment on methicillin resistant Staphylococcus aureus (MRSA) experimental osteomyelitis. Thirty-six rabbits with chronic MRSA osteomyelitis of the right femur were treated with local grepafloxacin delivery system prepared by a mixture of acrylic bone cement (polymethyl methacrylate, PMMA) plus 4% grepafloxacin. Osteomyelitis was induced by inoculating MRSA (100 microl of cultured bacteria; 10(7)) and the local insertion of a needle, serving as a foreign body, at the upper third of the femur. The course of the infection was followed by clinical, radiographic and microbiological examination. In the third week, all animals were re-operated, needles were removed, and antibiotic containing acrylic cement was implanted. Thereafter, one control and five treated animals were sacrificed per week, within 6 weeks. Osteomyelitis was found in all rabbits. In vitro grepafloxacin levels remained high throughout the 6 weeks of the experiment. Histologically tissue reaction against the cement was not observed. Osteomyelitis lesions and bone structure were progressively repaired after cement implantation. Biomechanical analysis showed no significant influence on the mechanical properties of acrylic cement due to grepafloxacin. The above mixture could prove to be an important supplementary method for the treatment of bone infections. Such a system could replace the use of gentamycin PMMA beads in the treatment of patients with chronic osteomyelitis due to MRSA. Furthermore, the proposed method could be used as a spacer after removal septic loosened prostheses in combination with systemic administration of antibiotics.