Complications and its impact in patients with closed and open tibial shaft fractures requiring open reduction and internal fixation.

Aim: To evaluate the rates of infection and nonunion and determine the impact of infections on healthcare resource use and costs following open and closed fractures of the tibial shaft requiring open reduction internal fixation. Methods: Healthcare use and costs were compared between patients with and without infections following pen reduction internal fixation using MarketScan® databases. Results: For commercial patients, the rates of infection and nonunion ranged from 1.82 to 7.44% and 0.48 to 8.75%, respectively, over the 2-year period. Patients with infection had significantly higher rates of hospital readmissions, emergency room visits and healthcare costs compared with patients without infection. Conclusion: This real-world study showed an increasing rate of infection up to 2 years and infection significantly increased healthcare resource use and costs.

Complications in type III open tibial shaft fractures treated with open reduction and internal fixation.

Aim: To estimate rates of fracture-related infection (FRI) and nonunion and assess the healthcare burden associated with FRI among patients with open reduction and internal fixation (ORIF) for Type III open tibial shaft fractures (TSFs). Methods: Patients with type III TSF requiring ORIF were identified using MarketScan® Database. Healthcare utilization and total costs were compared using generalized linear models. Results: The rates of FRI and nonunion were 35.99 and 36.94%, respectively, at 365 days. Patients with FRI had a significantly higher rate of readmission, emergency room visit and total healthcare costs compared with patients without FRI. Conclusion: Patients with an ORIF procedure for Type III TSF have a high risk of FRI and nonunion and; FRI significantly increased the healthcare burden.

Evaluation of smooth muscle cell response using two types of porous polylactide scaffolds with differing pore topography.

The goal of tissue engineering is to create bioartificial tissues for the replacement of failed or nonfunctional tissue. Porous tissue-engineered scaffolds may be created through a solvent-casting/porogen-leaching technique. Almost exclusively, sodium chloride (NaCl) is the porogen of choice. Previous studies have demonstrated the importance of porosity and pore size in cell adhesion and tissue development, yet the impact of porogen morphology and the chemical effect of porogen residual has not been fully explored. Poly-L-lactide (PLLA) scaffolds were manufactured by a solvent-casting, particulate-leaching method with either glucose or NaCl porogen in an effort to vary pore characteristics and, subsequently, cell adhesion and tissue development. Porogen influence on scaffold morphology and topography was compared via histological techniques and qualitative surface characteristics. Using an in vitro model, scaffolds were seeded with rat aortic smooth muscle cells (SMCs) and evaluated over a 28-day period. Cell attachment and proliferation were subsequently evaluated. Results indicate that initial SMC attachment is higher for scaffolds manufactured with NaCl rather than glucose. The proliferation of SMCs was higher for scaffolds manufactured with glucose and, by day 28, scaffolds manufactured with glucose supported a higher cell population than those processed using NaCl porogen.

Characterization of cellular carriers for use in injectable tissue-engineering composites.

Injectable composite tissue-engineering scaffolds are systems that incorporate individual cell carriers within a gel delivery matrix. This study assessed low-temperature casting as a possible method to produce synthetic cell-carrier beads. Porous poly-L-lactide beads were manufactured by low-temperature casting. Two porogens, either glucose or sodium chloride, were incorporated into the beads and subsequently leached. Beads were seeded with primary culture aortic smooth muscle rat cells and were evaluated over a 13-day period using a series of chemical, biochemical, and histological assays. Results indicate that low-temperature casting is a viable technique to produce injectable beads on the order of 1.5-2.0 mm. The manufactured beads supported smooth muscle cell attachment and proliferation; where the beads formed with sodium chloride allowed enhanced proliferation. Differences in physical qualities, namely buoyancy and topography, were dependent on porogen selection and may provide a mechanism for bead and composite customization.