Genicular nerve radiofrequency denervation, blocks, and neurolysis are effective techniques for pain from knee osteoarthritis (OA) by targeting specific sensory nerves. However, anatomical variability related to laterality and sex may influence targeting accuracy. This study systematically evaluated these factors to optimise procedural precision. Twenty-seven frozen lower limbs (10 bilateral: 6 females and 4 males; 7 unilateral: 5 males and 2 females; mean age 84.5 ± 10.8 years) were dissected from the proximal thigh to the knee following colored latex injection. Nerve diameters and distances from genicular nerves to relevant bony landmarks were measured and compared by sex and side using standard statistical tests (p < 0.05). No significant differences were observed in the distances from the target points to the bony landmarks between either men and women or left and right sides. These were larger, on average, in males than in females, except for the distance from the superomedial genicular nerve (SMGN) to the medial condyle. The inferomedial genicular nerve (IMGN) measured diameter at the target point was statistically larger in females than in males [p = 0.04(CI; -0.39–0.05)]. Interestingly, 44.4

BACKGROUND:Open fractures and complex traumatic wounds remain a major cause of morbidity in low- and middle-income countries, where delayed presentation, limited reconstructive capacity, and restricted access to specialized wound care complicate management. Although negative-pressure wound therapy is increasingly used as an adjunct in complex wound management, evidence specific to low- and middle-income countries remains limited and practical consensus recommendations are lacking. PURPOSE:To develop evidence-informed consensus recommendations for negative-pressure wound therapy use in orthopedic trauma and complex wounds in low- and middle-income countries and validate them through a multinational African modified Delphi process. METHODS:A narrative literature review identified evidence regarding negative-pressure wound therapy in orthopedic trauma and complex wounds, with particular emphasis on low- and middle-income countries settings. Draft recommendations were developed by the writing committee and externally validated through a modified Delphi process involving orthopedic-trauma and plastic surgeons from across Africa. Recommendations were initially classified as strong, moderate, or conditional and evaluated by the expert panel. Consensus was predefined as ≥ 80% agreement with the proposed recommendation category, while ≥ 90% agreement was considered very strong consensus. RESULTS:Forty-five experts were invited to participate, and forty completed the survey (response rate 88.9%). Fourteen draft recommendations were evaluated. Two achieved very strong consensus (≥90% agreement), eight achieved strong consensus (80-89%), and four did not reach the predefined threshold and were revised according to the predominant opinion of the panel. Agreement was highest for recommendations emphasizing negative-pressure wound therapy as an adjunct to standard open fracture management, adequate surgical debridement before negative-pressure wound therapy application, and timely definitive soft-tissue reconstruction. Lower agreement concerned technical parameters and organizational aspects, reflecting limited evidence and variability in local resources. CONCLUSION:These recommendations represent a multinational African modified Delphi consensus on negative-pressure wound therapy use in orthopedic trauma and complex wounds in low- and middle-income countries. By integrating the best available evidence with broad expert experience, they provide a pragmatic framework to support safe, context-adapted negative-pressure wound therapy implementation in resource-constrained settings while identifying areas requiring further clinical research.

BACKGROUND:Joint replacement is standard of care for chronic knee osteoarthritis, but can cause persistent postsurgical pain. Radiofrequency denervation helps treat chronic knee pain, though its effectiveness is lower in patients with knee arthroplasty than in those with native knees. Our goal was to compare genicular nerve targets in native and prosthetic cadaveric knees and see if targets need modification after arthroplasty. METHODS:10 native and 10 prosthetic knees from deceased donors underwent latex arterial injection and detailed dissection of the genicular nerves, comparing their origin, course, target points, diameter, and proximity with arterial blood vessels. RESULTS:Minimal differences among genicular nerve targets were observed between the two groups. The prosthetic knees had fibrotic adhesions of the infrapatellar branch of the saphenous nerve (IPBSN) due to previous surgery, potentially causing postsurgical neuromas and neuritis. The average nerve diameter at target points was smaller in prosthetic than native knees. The distance from the target point to the joint line was shorter for the superomedial genicular nerve in the prosthetic knee group (4.00±0.43 cm vs 4.53±0.75 cm, p=0.005). Nine native and eight prosthetic knees lacked an arterial branch near the target point of the superolateral genicular nerve (SLGN). CONCLUSION:Prosthetic knees share comparable genicular nerve anatomic locations with native knees but exhibit smaller nerve diameters and fibrosis of the IPBSN. The absence of a nearby arterial branch to the SLGN may reduce ultrasound targeting accuracy. Anatomical differences alone, however, do not fully explain the diminished pain relief observed after radiofrequency ablation.

Background/Objectives: War-related mandibular injuries result in extensive soft-tissue damage, severe comminution, and bone loss, and are associated with high rates of infection and delayed healing. No universally accepted management protocol exists for these injuries. External fixation is commonly used in this context, particularly when internal fixation is unavailable or contraindicated. This study aimed to analyze injury patterns, treatment outcomes, and complications of war-related mandibular fractures treated with external fixation as a primary and definitive stabilization method in a resource-limited setting in eastern Democratic Republic of Congo. Methods: A retrospective review was conducted of all patients who sustained war-related mandibular fractures and were treated with external fixation between January 2017 and December 2024 at the Hôpital Provincial Général de Référence de Bukavu. Demographic data, injury characteristics, treatment details, outcomes, and complications were collected. Factors associated with delayed union and fracture-related infection were evaluated using univariate analysis. Results: Ninety-one patients with severe mandibular war injuries were included. High-velocity gunshot wounds accounted for 94.5% of injuries. Clinical evidence of wound infection at admission was present in 29.7% of patients. The mean delay between injury and external fixation was 9.2 ± 6.6 days. Successful bone healing without secondary bone procedures was achieved in 71 patients (78.0%), with a mean healing time of 7.6 ± 3.0 weeks. Delayed bone grafting was required in 20 patients (22.0%), performed at a mean of 77.3 ± 30.5 days after initial fixation. The overall complication rate was 36.3%, with fracture-site infection being the most frequent complication (30.8%). Bone loss at presentation, clinical infection at admission, and the need for bone grafting were significantly associated with fracture-related infection (p < 0.05). Conclusions: War-related mandibular fractures in this series were characterized by severe comminution, bone loss, infection, and delayed presentation. Despite these challenges, external fixation provided acceptable fracture healing and functional outcomes. Small orthopedic external fixators represent a pragmatic and effective treatment option for complex mandibular war injuries in resource-limited settings.

Aims The optimal duration of antibiotic therapy in joint infection remains controversial, particularly as native joint septic arthritis and periprosthetic joint infection (PJI) differ substantially in pathophysiology, surgical management, and prognosis. While short antibiotic courses have been advocated for native joints after adequate drainage, prolonged therapy is often recommended for PJIs due to biofilm-related infection. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare short- with long-course antibiotic strategies in both native and prosthetic joint infections. Methods Following PRISMA guidelines, a systematic search was performed across PubMed, Embase, Web of Science, and the Cochrane Library. Only RCTs were included. Studies were assessed for inclusion using predefined population, intervention, comparison, outcomes, and study (PICOS) criteria. Meta-analyses were conducted using MedCalc, and treatment failures were analyzed using odds ratios (ORs) with 95% CIs. Results A total of 12 RCTs involving 1,414 patients (native 577; periprosthetic 837) were included, with six eligible for meta-analysis. For PJIs, long-course therapy (≥ 12 weeks) significantly reduced treatment failure compared with short courses (OR 2.04, 95% CI 1.18 to 3.54; p = 0.011), while complication and mortality rates were similar. In contrast, for native joints, short-course therapy (≤ four weeks) achieved comparable infection control with prolonged regimens (OR 1.347; p = 0.565) when combined with adequate surgical drainage, particularly in paediatric populations. Surgical strategy (e.g. debridement, antibiotics, and implant retention vs one- or two-stage exchange) influenced outcomes more than antibiotic duration alone. Conclusion Optimal antibiotic duration should be individualized based on joint type and surgical approach. Short courses are effective for native septic arthritis with proper drainage, whereas PJIs generally require extended therapy due to biofilm-related complexity. We propose the Age-Joint-Immunity-Surgery-Sensitivity (AJISS) score as a decision-making tool to guide treatment duration, warranting prospective validation. Cite this article: Bone Jt Open 2026;7(3):394–406.

Background: Fracture-related infection (FRI) represents one of the most challenging complications in trauma care and disproportionately affects patients in low-resource settings, where diagnostic capacity, surgical infrastructure, and access to microbiology and reconstructive expertise are limited. Methods: An expert group was convened through the African Bone and Joint Infection Network (ABJIN) under the auspices of the European Bone and Joint Infection Society (EBJIS) and with support from the AO Alliance. Recommendations were developed through a three-step process: (1) a two-part survey assessing current practice and priority needs among clinicians from African countries, (2) an in-person multidisciplinary consensus meeting during the COSECSA Congress (Harare, 2024), and (3) an iterative collaborative review by a wider panel of clinicians from 14 countries. Results: The group produced context-adapted recommendations covering prevention, terminology, diagnosis, investigations, holistic patient optimization, antimicrobial therapy, local antibiotic delivery, and surgical management of FRI in low-resource settings. Key themes include the following: management of open fractures; diagnostic pathways prioritizing clinical criteria and intra-operative sampling; antimicrobial strategies reflecting local microbiology and drug availability; affordable local antibiotic carriers; and the importance of soft-tissue management, multidisciplinary collaboration, and centralization of complex cases. Barriers specific to low-resource settings - delayed presentation, restricted microbiology services, limited implant availability, and high burdens of comorbidities - were integrated into the recommendations. Conclusion: These consensus-based, context-specific recommendations provide practical guidance for FRI in low-resource settings. They aim to support clinicians in delivering safe, cost-effective care, accepting structural limitations while promoting standardization and audit. Further clinical research from low- and middle-income countries is needed to strengthen the evidence base and refine these recommendations.

Aims:The optimal duration of antibiotic therapy in joint infection remains controversial, particularly as native joint septic arthritis and periprosthetic joint infection (PJI) differ substantially in pathophysiology, surgical management, and prognosis. While short antibiotic courses have been advocated for native joints after adequate drainage, prolonged therapy is often recommended for PJIs due to biofilm-related infection. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare short- with long-course antibiotic strategies in both native and prosthetic joint infections. Methods:Following PRISMA guidelines, a systematic search was performed across PubMed, Embase, Web of Science, and the Cochrane Library. Only RCTs were included. Studies were assessed for inclusion using predefined population, intervention, comparison, outcomes, and study (PICOS) criteria. Meta-analyses were conducted using MedCalc, and treatment failures were analyzed using odds ratios (ORs) with 95% CIs. Results:A total of 12 RCTs involving 1,414 patients (native 577; periprosthetic 837) were included, with six eligible for meta-analysis. For PJIs, long-course therapy (≥ 12 weeks) significantly reduced treatment failure compared with short courses (OR 2.04, 95% CI 1.18 to 3.54; p = 0.011), while complication and mortality rates were similar. In contrast, for native joints, short-course therapy (≤ four weeks) achieved comparable infection control with prolonged regimens (OR 1.347; p = 0.565) when combined with adequate surgical drainage, particularly in paediatric populations. Surgical strategy (e.g. debridement, antibiotics, and implant retention vs one- or two-stage exchange) influenced outcomes more than antibiotic duration alone. Conclusion:Optimal antibiotic duration should be individualized based on joint type and surgical approach. Short courses are effective for native septic arthritis with proper drainage, whereas PJIs generally require extended therapy due to biofilm-related complexity. We propose the Age-Joint-Immunity-Surgery-Sensitivity (AJISS) score as a decision-making tool to guide treatment duration, warranting prospective validation.

Introduction : La maîtrise de l’antibiothérapie et le traitement arthroscopique constituent deux avancées majeures dans le traitement des arthrites septiques. L’objectif de cette étude était d’évaluer les résultats cliniques et fonctionnels du traitement arthroscopique de l’arthrite septique du genou sur articulation native dans un hôpital camerounais. Méthodes : Il s’agissait d’une étude transversale avec une collecte prospective des variables. Les patients ont été opérés entre janvier 2022 et décembre 2024. Les adultes ayant une arthrite septique du genou étaient inclus. Tous les patients ont été traités par irrigation abondante et débridement/synovectomie par voie arthroscopique. Une antibiothérapie systémique adaptée aux résultats bactériologiques était associée. Les paramètres évalués étaient la douleur, l’amplitude articulaire, la vitesse de sédimentation (VS), la protéine C-réactive (CRP), le taux de réintervention, et les caractéristiques microbiologiques. Résultats : La population était composée de 22 patients (22 genoux). L’âge moyen des patients était de 28 ans. Six patients étaient drépanocytaires. Au recul moyen de 6 mois, les genoux étaient indolores (n=20), avec une flexion moyenne de 118°. La CRP et la VS s’étaient normalisées au bout de la quatrième semaine (n=14). Une reprise arthroscopique a été faite chez cinq patients. Un seul patient a nécessité une conversion en arthrotomie. Le Staphylococcus aureus a été isolé chez dix patients. Conclusion : Cette étude montre que l’arthroscopie associée à une antibiothérapie précoce permet un contrôle de l’infection, une bonne récupération fonctionnelle et des résultats radiologiques satisfaisants. Son développement dans les pays à ressources limitées doit être encouragé. Mots-clés : Arthrotomie, Chirurgie arthroscopique, Infection ostéoarticulaire, Pays à ressources limitées

Bone is the second most frequently transplanted human tissue worldwide. In sub-Saharan Africa, donor and recipient consent for bone allograft donation and transplantation remains uncertain due to diverse sociocultural, religious, and socioeconomic contexts. This study assessed public attitudes toward bone allograft donation and transplantation in Cameroon, the Democratic Republic of Congo, and the Republic of Côte d’Ivoire to support the planning and implementation of bone banking programs. A multicountry cross-sectional survey was conducted between January and December 2024. Six hundred adults were recruited using a non-probabilistic, stratified convenience sampling in urban and rural settings. After informed consent, participants completed a structured questionnaire, self-administered whenever possible capturing sociodemographic data, willingness to donate and receive bone allografts, and perceived reasons for refusal. Descriptive analyses and univariate and multivariate logistic regression models were used to identify factors associated with willingness. The mean age of participants was 36.2 years. Overall, 72.5

Implant-associated infections caused by biofilm-forming bacteria, such as Staphylococcus aureus, remain a major clinical challenge due to their high tolerance to conventional antibiotic therapies. We report a dual-targeted therapeutic strategy that combines a tri-enzymatic cocktail designed to degrade key components of the biofilm matrix (TEC; comprising a DNA/RNA endonuclease, an endo-1,4-β-D-glucanase, and a β-N-acetylhexosaminidase), with vancomycin, both delivered via a thermosensitive poloxamer 407 hydrogel, for localized treatment of S. aureus biofilms. The formulation was evaluated both in vitro, on titanium-adherent biofilms, and in vivo, using a model of tissue cages containing titanium beads implanted in the back of guinea pigs. Animals additionally received intraperitoneal administration of vancomycin alone or combined with rifampicin. In vitro, this formulation enabled sequential drug release, with TEC delivered within the first 24 h and vancomycin for up to 96 h, and achieved >5 Log₁₀ reductions in CFU counts after two applications at 48 h interval. In vivo, biofilm-associated bacterial counts reached the detection limit (100 CFU; >5 Log10 decrease from the initial inoculum) in 75

Introduction : La mise en place de la prothèse totale du genou (PTG) est peu documentée en Afrique subsaharienne. L’objectif de cette étude était d’évaluer les résultats anatomiques et fonctionnels d’une série initiale continue de PTG à l’Hôpital Général de Yaoundé (Cameroun). Patients et méthode : il s’agissait d’une étude observationnelle, de type cohorte menée entre Août 2023 et Juillet 2025, incluant tous les patients opérés pour une PTG primaire et suivis pendant au moins 12 mois. Les variables étudiées étaient sociodémographiques, cliniques (douleur, score IKS, satisfaction), radiologiques (angle HKA), les complications et la qualité de vie (SF-12) avant la chirurgie et à un an de recul postopératoire. Résultats Trente-sept PTG ont été posées chez 37 patients. L’âge moyen des patients était de 67,5± 10,7 ans. Il y avait une déviation angulaire dans 33 (89%) cas. L’intensité moyenne de la douleur était significativement réduite, de 8,0 ± 0 à 2,0 ± 1,3 (p=0,001). Il y’avait une amélioration significative du score IKS global (54,01 ± 21,79 vs 147,06 ± 21,79 ; p=0,001). L’axe mécanique du genou était restauré chez 35 (95 %) patients. La flexion et l’extension moyennes du genou ont été significativement améliorées, passant respectivement de 75 ± 20° à 110 ± 15° (p=0.005), et de 165 ± 10° à 175 ± 5° (p=0.01). Le taux de satisfaction était de 87 %. Les complications incluaient l’infection précoce (5%) et le descellement aseptique (5%). Le taux de survie prothétique à un an était de 97 %. La mortalité péri-opératoire était nulle. Conclusion : Cette étude montre que la PTG, à Yaoundé, donne de résultats cliniques et radiologiques satisfaisants à court terme, confirmant sa faisabilité et sa sécurité dans un contexte à ressources limitées. Mots clés : Déformations axiales du genou- Gonarthrose- Pays à ressources limitées- Prothèse totale du genou.

ABSTRACT Meropenem is a valuable option for outpatient parenteral antimicrobial therapy (OPAT) due to its broad-spectrum activity, including multidrug-resistant Gram-negative bacteria, particularly when no oral alternatives exist. However, its conventional thrice-daily dosing poses logistical challenges for home administration, as the third dose typically falls during nighttime. This prospective pharmacokinetic study evaluated the adequacy of a novel daytime-only meropenem regimen adapted for OPAT in non-critically ill hospitalized patients. Twenty-two patients receiving meropenem 2 g every 8 h were switched, once clinically stable, to a thrice-daily, 6-hourly regimen compatible with daytime administration only. Meropenem was infused over 20 min. At steady state, unbound meropenem concentrations were measured for both regimens. These data informed a population pharmacokinetic model and Monte Carlo simulations to compare the probability of achieving predefined PK/PD targets. Both the conventional and OPAT-adapted regimens achieved a probability of target attainment (PTA) >90% for 40% f T >MIC at MIC ≤4 mg/L, exceeding the EUCAST/IDSA susceptibility breakpoint of 2 mg/L. Extending the infusion duration to 3 or 5 h with the OPAT-adapted schedule restored PTA >90% for MIC ≤8 mg/L. However, trough concentrations after the evening dose were lower with the OPAT-adapted regimen than with the standard regimen (1–2 vs 3–5 mg/L, depending on infusion duration). This may increase the risk of resistance selection despite the post-antibiotic effect of meropenem. With this caveat, OPAT regimens, with infusion duration adapted to MIC, may enable practical daytime-only meropenem administration, avoiding the need for overnight nursing visits.

Introduction:The difficulties of managing bone loss in the distal tibia are well known in the literature. The various therapeutic options available to us include custom prosthetic replacement, talocrural arthrodesis with allograft, vascularised or non-vascularised autograft, bone transfer according to Illizarov and insertion of a metal augment. In the case of non-conservation of the talocrural joint, osteosynthesis is performed using adapted plates and screws or, more conventionally, transplanted centromedullary nailing. We report on a clinical case of bone loss in the distal tibia in an infectious context, using an innovating talocrural arthrodesis reconstruction technique with allograft insertion at the level of the bone defect. Fixation was achieved with an anterograde tibiotalar nailing, which enabled preservation of the subtalar joint and compliance with the biomechanical principles of stable fixation. Case Report:We report the clinical case of a 40-year-old patient with osteitis of the distal tibia following open trauma which required multiple surgeries of the osteosynthesis and cover flap type. The uncontrolled infection and skin fistulation led to a two-stage operation. The first stage consisted of resection of 9 cm of infarcted distal tibia, bacteriological samples were also taken, a cement spacer was inserted, temporary fixation was provided by an external fixator and appropriate antibiotic therapy was administered for a period of 3 months. The second stage of the operation took place six weeks after the first and consisted of reconstruction using an intercalary distal tibial allograft and stabilization using an anterograde tibio-talar centromedullary nailing with stable static fixation. Demineralized bone matrix (DBM) was placed at the native bone-allograft junction. The patient's fellow up is 9 years, the complete bypass has been achieved with consolidation, the subtalar joint is preserved and the viability of the construct is maintained. Conclusion:Anterograde tibio-talar centromedullary nailing is a stable and reliable method of fixation in the management of distal tibial bone defects with talocrural arthrodesis.

Data on the implementation of international consensus guidelines for fracture-related infection (FRI) in low- and middle-income countries (LMICs) are scarce. This study assessed whether FRI diagnosis and management in an LMIC align with these recommendations. Methods: We conducted a prospective multicenter study across four tertiary hospitals in Yaoundé, Cameroon (September 2022-July 2025). All consecutive patients with a working FRI diagnosis were included. Confirmatory/suggestive diagnostic criteria and treatment strategies were assessed against consensus guidelines. Results: A total of 169 patients were included (mean age 39.4 ± 15.4 years; 72.7 % male). In 34.3 % of cases, FRI occurred without prior surgery, limiting applicability of the Willenegger and Roth classification. Clinical confirmatory criteria were present in 97 % of cases. Microbiological standards were seldom achieved: none fulfilled sampling quantity, and only 46.6 % met sampling method recommendations. A microbiological confirmatory criterion was documented in 36 patients (21.3 %); histopathology was rarely performed (1.2 %), and nuclear imaging was not used. Most patients (81.1 %) were on antibiotics before admission or surgery. The most common treatment strategies were suppressive antibiotic therapy (44.4 %); one-stage (11.2 %) or two-stage (10.7 %) debridement, antibiotics, and implant exchange (DAIEX); and debridement, antibiotics, and implant retention (DAIR; 9.5 %). Overall, 62.7 % of treatments deviated from consensus guidelines. Conclusion: Nearly two-thirds of FRIs in this LMIC setting were managed outside international consensus guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Context-adapted, evidence-based guidelines are urgently needed to improve outcomes where the burden is highest.

BACKGROUND:Short-stem total hip arthroplasty (THA) has gained popularity due to its bone-preserving design, reduced stress shielding, and facilitation of future revisions. However, concerns persist regarding a higher incidence of complications especially during the learning curve. The feasibility of revising Fitmore short stems using either a new short or a standard primary stem, rather than dedicated revision implants, remains debated. METHODS:We retrospectively reviewed 44 consecutive revisions following primary implantation of a Fitmore® metaphyseal short stem. Revision femoral components were classified as short, primary, or revision stems. Indications for revision, stem choice, and outcomes were analyzed. RESULTS:Revision was performed using a short stem in 11 cases, a standard primary stem in 26 cases, and a revision stem in 7 cases. Mean follow-up was 69 months. The mean Harris Hip Score was 82.3 ± 8.4. Two patients (4.5%) required re-revision, one due to traumatic periprosthetic fracture and the other for hematogenous infection. CONCLUSION:Revision of failed short-stem THA using new short stem or standard primary stems is feasible in the vast majority of cases, with excellent mid-to long-term outcomes and a low re-revision rate. These findings challenge the notion that short stem revisions inherently require complex revision implants. LEVEL OF EVIDENCE:IV; Retrospective consecutive case series.

Last twenties, tissue engineering has rapidly advanced to address the shortage of organ donors. Decellularization techniques have been developed to mitigate immune rejection and alloresponse in transplantation. However, a clear definition of effective decellularization remains elusive. This study compares various decellularization protocols using the human fascia lata model. Morphological, structural and cytotoxicity/viability analyses indicated that all the five tested protocols were equivalent and met Crapo's criteria for successful decellularization. Interestingly, only the in vivo immunization test on rats revealed differences. Only one protocol exhibited Human Leucocyte Antigen (HLA) content below 1% residual threshold, the only criterion preventing rat immunization with an absence of rat anti-human IgG switch after one month (N=4 donors for each of the 7 groups, added by negative and positive controls, n=28). By respecting a refined set of criteria, i.e. lack of visible nuclear material, <50ng DNA/mg dry weight of extracellular matrix, and <1% residual HLA content, the potential for adverse host reactions can be drastically reduced. In conclusion, this study emphasizes the importance of considering not only nuclear components but also major histocompatibility complex in decellularization protocols and proposes new guidelines to promote safer clinical development and use of bioengineered scaffolds.

The surface immobilization of LL-37, a cationic antimicrobial peptide, offers a promising route for developing antibacterial coatings. In this study, two different strategies were used to immobilize LL-37: (i) bare LL-37 molecules were directly assembled layer-by-layer (LbL) with negatively-charged heparin (Hep), and (ii) LL-37 was first complexed with Hep, forming peptide-polyelectrolyte complexes (PPCsLL-37-Hep) which were then LbL-assembled with positively-charged chitosan (Chi). The multilayer architecture and LL-37 release behavior were expected to vary depending on the assembly strategy, which may in turn affect the obtained antibacterial properties. Here, X-ray photoelectron spectroscopy (XPS) was used to determine the composition of the thin films, i.e., the relative proportions of Hep, Chi, and LL-37 in the multilayers. These proportions were estimated by combining XPS peak analysis with stoichiometric modeling, based on the theoretical degree of protonation of the charged moeities and the use of sulfur as a specific marker for Hep. However, discrepancies between the modeled values and the XPS data revealed that theoretical assumptions could not fully account for the measurements, and modeling was then refined for improved accuracy using empirical protonation degrees. The results show that a higher proportion of LL-37 is retained in the antimicrobial films when using bare LL-37 compared to PPCsLL-37Hep, likely due to molecular rearrangement following the addition of Chi to the previous PPCsLL-37-Hep layer, which induces partial LL-37 release. The developed methodology, based on in-depth exploitation of XPS data, enables a more advanced characterization of these antimicrobial films and may guide their synthesis and performance optimization.

Implant-associated infections remain a critical challenge due to the presence of biofilm-forming bacteria, which enhance tolerance to conventional treatments. This study investigates the efficacy of a tri-enzymatic cocktail (TEC; DNA/RNA endonuclease, endo-14-β-d-glucanase, β-N-acetylhexosaminidase) targeting biofilm matrix components combined with supratherapeutic doses of antibiotics encapsulated in a thermosensitive hydrogel (poloxamer P407) for local administration. In vitro, the hydrogel formulation enabled controlled release of active agents over 12 h. Vancomycin and TEC co-formulated in hydrogel achieved up to 3.8 Log10 CFU count reduction and 80 % biofilm biomass reduction on MRSA biofilms grown on titanium coupons, demonstrating enhanced efficacy as compared to individual active agents, with 1.3-3.2 log10 additional killing. Fluoroquinolone efficacy remained unchanged by enzyme addition. In vivo, in a model of tissue cages containing titanium beads implanted in the back of guinea pigs, hydrogel-delivered vancomycin maintained therapeutic levels for seven days. Coupled with an intraperitoneal administration of vancomycin for 4 days, a single local administration of hydrogel containing both vancomycin and TEC was more effective than hydrogels containing either vancomycin or TEC, achieving an additional 2.1 Log10 CFU reduction compared to local vancomycin, 2.3 Log10 compared to local TEC, and 4.3 Log10 compared to systemic vancomycin treatment alone. However, partial regrowth occurred at later stages, indicating room for further optimization. Nevertheless, these findings already underscore the potential of combining a high dose of antibiotic with an enzymatic cocktail in a sustained-release hydrogel delivery system as a promising strategy for improving the management of biofilm-associated implant infections.

Background/Objectives: In maxillo-facial high-velocity complex war injuries, a rigid internal fixation is inappropriate, and external fixation is suitable with described benefits. This systematic review aimed to summarize the literature regarding the benefits, side effects and complications of external fixators in the management of mandibular war-related injuries. Methods: An electronic search was performed in the databases of PubMed and Google Scholar in December 2024. The title and abstracts from retrieved items were read by two reviewers to identify studies within the selection criteria. Included articles had to be published in English up to December 2024 and related to external fixators used in mandibular fracture war injuries. Results: The search strategy initially identified 445 studies through PubMed and 987 studies through Google Scholar. Following the application of inclusion criteria, 12 articles were selected for this review, describing the use of an external fixator for a mandibular fracture in a war injury. Conclusions: The external fixator offers effective treatment for severe mandibular fractures in war-related injuries with low rates of complications and high success rates. Where a manufacturer external fixator is not available, orthopedic external fixators and self-crafted external fixators are used.