An intramedullary nail coated with antibiotic and growth factor nanoparticles: An individualized state-of-the-art treatment for chronic osteomyelitis with bone defects.

Among various infections, chronic osteomyelitis is one of the most challenging in terms of treatment. This infection is more common among patients with open fractures and those who have undergone elective orthopedic procedures. The treatment of osteomyelitis requires high antibiotic doses and an aggressive and multifaceted surgical approach. The use of parenteral antibiotics alone, without debridement, is not sufficiently effective, due to the formation of sequestra and the low vascularity of the affected area. The surgical options available for patients with chronic osteomyelitis include sequestrectomy, curettage, and intramedullary reaming, although these procedures usually result in bone defects that require further surgical intervention. Polymethyl methacrylate or calcium phosphate beads, impregnated with antibiotics, are commonly placed in such cases; however, this option has several disadvantages, including the need for future removal of cement, uncontrollable local release of antibiotics, and the need for broad-spectrum agents. The resulting bone defects also require additional treatments involving vascularized fibula grafting, intramedullary nails, use of techniques like Masquelet and Ilizarov, and even soft tissue transfers. All of these methods have certain limitations, such as the eventual requirement of more than one surgical event. Certain growth factors aid in the development and vascularization of new bone, such as bone morphogenetic proteins (BMPs) and insulin-like growth factor I (IGF-1). We propose that nanoparticles of BMPs, IGL-1, and microorganism-specific antibiotics can be placed on the surface of intramedullary nails. These nanoparticles can be attached to various different polymeric materials such as poly(d,l-lactide), which is a biocompatible and biodegradable polymer, and can be positioned in several layers, to ensure controlled and systematic release. The placement of nanoparticles at the infection site alone will also ensure local delivery of the drugs only to the required areas. Moreover, these intramedullary nails will be useful for both infected non-unions and mal-unions. Over time, the nanoparticles will eradicate the infection and stimulate new healthy bone formation, whereas the intramedullary nail itself will provide constant stability and immobilization. This model provides new and revolutionary ideas for the development of individualized technologies in medicine.

The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells-Their Current Uses and Potential Applications.

Only select tissues and organs are able to spontaneously regenerate after disease or trauma, and this regenerative capacity diminishes over time. Human stem cell research explores therapeutic regenerative approaches to treat various conditions. Mesenchymal stem cells (MSCs) are derived from adult stem cells; they are multipotent and exert anti-inflammatory and immunomodulatory effects. They can differentiate into multiple cell types of the mesenchyme, for example, endothelial cells, osteoblasts, chondrocytes, fibroblasts, tenocytes, vascular smooth muscle cells, and sarcomere muscular cells. MSCs are easily obtained and can be cultivated and expanded in vitro; thus, they represent a promising and encouraging treatment approach in orthopedic surgery. Here, we review the application of MSCs to various orthopedic conditions, namely, orthopedic trauma; muscle injury; articular cartilage defects and osteoarthritis; meniscal injuries; bone disease; nerve, tendon, and ligament injuries; spinal cord injuries; intervertebral disc problems; pediatrics; and rotator cuff repair. The use of MSCs in orthopedics may transition the practice in the field from predominately surgical replacement and reconstruction to bioregeneration and prevention. However, additional research is necessary to explore the safety and effectiveness of MSC treatment in orthopedics, as well as applications in other medical specialties.

Meniscectomía artroscópica. Seguimimento a cinco años en el Hospital ABC / Arthroscopic meniscectomy. Postoperative follow-up at five years in the ABC Hospital

La meniscectomía parcial artroscópica actualmente es el método más popular, para el tratamiento de lesiones meniscales. Creemos que los cambios degenerativos y la edad del paciente al momento de la artroscopía son determinantes para el pronóstico. Se revisó el expediente de 98 pacientes operados de meniscectomía parcial de rodilla por vía artroscópica en el Hospital ABC entre enero y diciembre de 1992. Se entrevistaron vía telefónica 56 pacientes con lesión de uno o ambos meniscos de una sola rodilla. Se formaron 4 grupos: IA: Pacientes menores de 40 años sin datos de lesión del cartílago articular. IB: Pacientes menores de 40 años con datos de lesión del cartílago articular. IIA: Pacientes mayores de 40 años sin datos de lesión condral. IIB: Pacientes mayores de 40 años con datos de lesión condral. El seguimiento fue de 5.4 años en promedio. La meniscectomía parcial es una buena opción terapéutica en menores de 40 años independientemente de la presencia de lesión condral. En los pacientes mayores de 40 años sin lesión condrial la reparación de menisco es la mejor opción, mientras que en los mayores de 40 años con lesión condral, se debe buscar la reparación del menisco combinado con otras técnicas de reparación al cartílago, sabiendo que esto puede ser sólo de manera paliativa