Trauma is a physical injury derived from the Greek word meaning “a wound”. It involves transfer of kinetic energy. Orthopedic trauma involves fractures, subluxation or dislocation of bones and joints. Trauma can be of varying degrees and efficient evaluation of the severity of trauma by using ATLS system helps plan an effective management.
Implants in Orthopedic Trauma:
Out of various other options for the surgical management of orthopaedic trauma, one involves application of an implant or a device for permanently or temporarily restoring the physiology or anatomy of joint or other skeletal structures. An orthopedic implant is a medical device build to replace or support a lost joint or a damaged bone. Surgeon picks the implant by assessing the weight, size and type most appropriate to the individual. The strength of the implant is provided by stainless steel and titanium alloys used in its production and topped with a plastic coating to act as an artificial cartilage. The operation in orthopedic surgery that involves the implementation of such implants for the purpose of repairing a damaged or lost bone is called internal fixation. Pins, rods, screws and plates are among the few types of medical implants that are used to fixate the fractured bones while allowing them to heal.
Prevention of Infections in Implants:
Major concerns faced with implants are prevention of infection and amalgamation of the implant with the host-tissue. Infection has long been a serious issue leading to limb amputations and even death due to septicemia. Properties of the prosthesis used, such as its chemical composition, hydrophobicity, roughness of the surface are all important factors in the incidence of infection after an orthopedic implantation.
Advent of Antibiotics:
S.aureus and S.epidermitis are the main causative agents of implant-related infections in orthopedic surgery. Thanks to the discovery of antibiotics, the incidence of infections has been reduced and so has the mortality and morbidity associated with it. But the extensive use of antibiotics has produced a number of evolving resistant bacterial strains.
A new method termed as coating is applied on the surface to further reduce the chances of bacterial invasion of the prosthetic and avoid loosening of the implant. These coatings are of different types such as antibiotic releasing and non-releasing coatings using different techniques such as active or passive methods. Hydroxyapatite is one of the non releasing coatings that require thermal method for application while dip or spray method is used to apply releasing coatings (antibiotic containing coatings) because of reduced thermal stability.
Implant removal is a common elective orthopedic operation that contributes 30% of planned surgical operations. In clinical practice the most common indications for implant removal include pain, irritation of soft tissue, and recommencement of strenuous activities after fracture healing or the patient’s demand. For children, it is important to remove implant early to avoid disturbances of the growing bone structure. Implant removal requires a second look operation as it may lead to scar tissue as well as increases chances of nerve damage.