Irrigation of the intramedullary channel improves outcome of DAIR in a sheep model

The management of fracture-related infection (FRI) with Debridement, Antibiotics, Irrigation, and Implant Retention (DAIR) is an appealing option, but its suitability is restricted to a relatively narrow proportion of patients. This study aimed to create a large animal model of DAIR after FRI and to evaluate outcomes after early (2 weeks) and delayed (5 weeks) DAIR. Additionally, intramedullary lavage (IML) of the intramedullary canal (IMC) is introduced as a novel technique to remove infected tissue. Our findings showed that DAIR failed to resolve infections in both early and delayed groups, whilst IML significantly reduced bacterial counts, leading to culture-negative results in the soft tissue and bone marrow. IML did not compromise long-term bone healing as revealed by an implant load sensor on the plate. In conclusion, DAIR was successfully achieved in a new large animal model with minimal losses. The IML method improves treatment efficacy, potentially broadening the range of patients suitable for DAIR.

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Publication Details

Journal
npj Biofilms and Microbiomes
Published
2025-02-24
DOI
https://doi.org/10.1038/s41522-024-00643-0
Citations
1
Primary Topic
Electrical and Bioimpedance Tomography
Type
article
Field-Weighted Citation Impact
0.73

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article

Irrigation of the intramedullary channel improves outcome of DAIR in a sheep model

Lena Gens, Manuela Ernst, T. Fintan Moriarty, Maja Waschk et al.
1 citations
npj Biofilms and Microbiomes
Electrical and Bioimpedance Tomography
0.73
article

Irrigation of the intramedullary channel improves outcome of DAIR in a sheep model

Lena Gens, Manuela Ernst, T. Fintan Moriarty, Maja Waschk, Claudia Siverino, Markus Windolf, Henning Richter, Tim Buchholz, Caroline Constant, Dominic Gehweiler, Niels Vanvelk, Mario Morgenstern, Stephan Zeiter, R. Geoff Richards
article en
1 citations

Abstract

The management of fracture-related infection (FRI) with Debridement, Antibiotics, Irrigation, and Implant Retention (DAIR) is an appealing option, but its suitability is restricted to a relatively narrow proportion of patients. This study aimed to create a large animal model of DAIR after FRI and to evaluate outcomes after early (2 weeks) and delayed (5 weeks) DAIR. Additionally, intramedullary lavage (IML) of the intramedullary canal (IMC) is introduced as a novel technique to remove infected tissue. Our findings showed that DAIR failed to resolve infections in both early and delayed groups, whilst IML significantly reduced bacterial counts, leading to culture-negative results in the soft tissue and bone marrow. IML did not compromise long-term bone healing as revealed by an implant load sensor on the plate. In conclusion, DAIR was successfully achieved in a new large animal model with minimal losses. The IML method improves treatment efficacy, potentially broadening the range of patients suitable for DAIR.

npj Biofilms and MicrobiomesVol. 11(1)
University of Zurich (CH), AO Foundation (CH), University Hospital of Basel (CH)
AO Foundation
Zero hunger
Openalex Percentile: Top 31%
Electrical and Bioimpedance Tomography
0.73
DOIOpen Access PDFOpenAlex
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