eCM (Eur Cell Mater / e Cells & Materials) Not-for-profit Open Access
Created by Scientists, for Scientists
 ISSN:1473-2262         NLM:100973416 (link)         DOI:10.22203/eCM

2018   Volume No 35 – pages 178-194

Title: Chlorhexidine-releasing implant coating on intramedullary nail reduces infection in a rat model

Authors: SM Shiels, M Bouchard, H Wang, JC Wenke

Address:  United States Army Institute of Surgical Research, Extremity Trauma and Regenerative Medicine Task Area, Joint Base San Antonio-Fort Sam, Houston, Texas, USA

E-mail: stefanie.m.shiels.ctr at

Abstract: The use of internal intramedullary nails for long bone fracture fixation is a common practice among surgeons. Bacteria naturally attach to these devices, increasing the risk for wound infection, which can result in non- or malunion, additional surgical procedures and extended hospital stays. Intramedullary nail surface properties can be modified to reduce bacterial colonisation and potentially infectious complications. In the current study, a coating combining a non-fouling property with leaching chlorhexidine for orthopaedic implantation was tested. Coating stability and chlorhexidine release were evaluated in vitro. Using a rat model of intramedullary fixation and infection, the effect of the coating on microbial colonisation and fracture healing was evaluated in vivo by quantitative microbiology, micro-computed tomography, plain radiography, three-point bending and/or histology. Low dose systemic cefazolin was administered to increase the similarities to clinical practice, without overshadowing the effect of the anti-infective coating. When introduced into a contaminated wound, the non-fouling chlorhexidine-coated implant reduced the overall bacteria colonisation within the bone and on the implant, reduced the osteolysis and increased the radiographic union, confirming its potential for reducing complications in wounds at high risk of infection. However, when implanted into a sterile wound, non-union increased. Further studies are required to best optimise the anti-microbial effectiveness, while not sacrificing fracture union.

Key Words: Surface modification, non-fouling coating, orthopaedic fixation, osteomyelitis, Staphylococcus aureus.

Publication date: March 22nd 2018

Article download: Pages 178-194 (PDF file)

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