Waterproof versus cotton cast liners: a randomized, prospective comparison.

Casting injured extremities can cause complications (eg, itching, odor, rashes, skin maceration), many of which are associated with the inability to wash the extremity because of water retention and slow drying of conventional cast liners. A waterproof cast liner allows casts to become wet and perhaps improves hygiene and comfort. Fifty-nine patients (age, > or = 10 years) with upper or lower extremity injuries were randomized to a waterproof-liner group (n = 29) or a cotton-liner group (n = 30). Both groups had casts made of fiberglass tape. At each clinic visit, patients and physicians completed questionnaires evaluating comfort and skin condition, respectively. The waterproof-liner group had better scores for itch (P = .008), discomfort (P < .001), irritation (P = .002), overall patient score (P = .012), and overall physician score (P = .049).

Tobramycin-impregnated calcium sulfate prevents infection in contaminated wounds.

Open fractures often are associated with increased rates of infection and nonunion, multiple surgical procedures, and delayed return to preinjury activity. Antimicrobial bone graft substitutes used as an alternative to antibiotic cement beads and/or delayed autologous bone grafting may provide a useful adjunct in patients with open fractures. A stable, unicortical defect was created and contaminated with 30 microL of 5 x 10 colony-forming units/mL of Staphylococcus aureus in the proximal tibial metaphysis of Spanish goats. The negative control group received no treatment, the carrier group received synthetic bone graft alone, the positive control group received tobramycin antibiotic cement, and the treatment group received tobramycin antimicrobial synthetic bone graft (calcium sulfate). After a 3-week evaluation period, intraosseous microbiologic specimens were obtained. The Staphylococcus aureus contaminant was recovered in 11 of 12 animals (mean = 6.9 x 10 colony-forming units/g marrow) in the negative control group and in all animals (mean = 2.2 x 10 colony-forming units/g marrow) in the carrier group. Bacteria were not found in the antibiotic-treated groups. The tobramycin-impregnated calcium sulfate was effective in preventing infection in a contaminated defect. It could be beneficial in reducing the number of surgeries and recovery time because it is bioabsorbable and osteoconductive.

In vivo comparison of a metal versus a biodegradable suture anchor.

PURPOSE: This protocol compares an absorbable polylactic acid (PLA) anchor to a similarly sized metallic anchor, comparing the load to failure of the suture anchor construct in vivo in a goat model. TYPE OF STUDY: Basic science. METHODS: Thirty-nine goats underwent bilateral implantation of suture anchors at the intra-articular origin of the long digital extensor tendon at the knee (stifle). Each goat randomly received an absorbable anchor in one knee and a metallic anchor in the other. At 0, 6, and 12 weeks after implantation, the suture attached to the implanted anchor was pulled to failure on a materials testing machine, annotating the load at failure and location of failure of the suture anchor construct. RESULTS: At each time period tested, no difference was found in failure load between metal and PLA suture anchor constructs, nor was there degradation in strength over time of implantation of either anchor. Most failures occurred by suture breakage, and the force required for suture breakage did not differ between anchors. Three absorbable PLA anchors failed, one (1 of 13, 7.7%) at 6 weeks, and 2 (15.4%) at 12 weeks. PLA anchor failure occurred when the suture loop eyelet pulled out of the anchor's PLA body. CONCLUSIONS: The absorbable PLA suture anchor construct, tested in an in vivo, intra-articular model, had similar strength over a 12-week period of implantation with a comparable metal anchor construct. These absorbable anchors offer a reasonable alternative to metal anchors, with comparable strength and function and advantages unique to an absorbable anchor. CLINICAL RELEVANCE: This study provides the reader with an evaluation of the in vivo function and holding strength over time of implantation of an absorbable suture anchor in comparison with a metal anchor.