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Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances
AN IN VITRO STUDY
T. M. Bielecki, T. S. Gazdzik, J. Arendt, T. Szczepanski, W. Król, T. Wielkoszynski
From the Medical University of Silesia, Katowice, Poland
Platelet-rich plasma is a new inductive therapy which is being increasingly used for the treatment of the complications of bonehealing, such as infection and nonunion. The activator for platelet-rich plasma is a mixture of thrombin and calcium chloride which produces a platelet-rich gel. We analysed the antibacterial effect of platelet-rich gel in vitro by using the platelet-rich plasma samples of 20 volunteers. In vitro laboratory susceptibility to platelet-rich gel was determined by the Kirby-Bauer disc-diffusion method.Baseline antimicrobial activity was assessed by measuring the zones of inhibition on agar plates coated with selected bacterial strains. Zones of inhibition produced by platelet-rich gel ranged between 6 mm and 24 mm (mean 9.83 mm) in diameter. Platelet-rich gel inhibited the growth of Staphylococcus aureus and was also active against Escherichia coli. There was no activity against Klebsiellapneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa. Moreover, platelet-rich gel seemed to induce the in vitro growth of Ps. aeruginosa, suggesting that it may cause an exacerbation of infections with this organism. We believe that a combination of the inductive and antimicrobial properties of platelet-rich gel can improve the treatment of infected delayed healing and nonunion.

T. M.Bielecki, MD, PhD, Orthopaedic Surgeon T. S. Gazdzik, MD, PhD, Professor Department and Clinic of Orthopaedics Medical University of Silesia, Pl. Medyków 1, 41-200 Sosnowiec, Poland. J. Arendt, MD, PhD, Professor Department and Clinic of General and Gastroenterological Surgery Medical University of Silesia, Ul. Zeromskiego 13, 41-300 Bytom, Poland. T. Szczepanski, MD, PhD, Pediatrician Department ofPediatric Hematology and Oncology Medical University of Silesia, Ul. 3 Maja 13-15, 41-800 Katowice, Poland. W. Król, MD, PhD, Professor Department of Microbiology and Immunology T. Wielkoszynski, MD, PhD, Senior Researcher Department of Biochemistry Medical University of Silesia, Ul. Jordana 19, 41-800 Katowice, Poland. Correspondence should be sent to Dr T. M. Bielecki; e-mail: tomekbiel@o2.pl©2007 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.89B3. 18491 $2.00 J Bone Joint Surg [Br] 2007;89-B:417-20. Received 3 August 2006; Accepted after revision 1 November 2006

Despite advances in surgical techniques, the treatment of open fractures continues to be associated with a high rate of delayed union and nonunion. When the healing of a fracture is delayed, asecondary intervention may be needed which may itself be associated with increased morbidity and a reduced quality of life. Consequently, the goal of the initial treatment should be to increase the likelihood of union.1,2 Several factors influence the development of nonunion. These include the location and type of fracture, the skill of the surgeon, and complicating infection. The success of secondarytreatment depends upon various factors, including the type of nonunion, the application of osteoinductive and osteoconductive biomaterials, the method of stabilisation used, any concomitant infection and the general health of the patient. Deep infection may not respond to surgical management and infection precludes the use of biomaterials. The conventional methods for the treatment of nonunionrequire considerable improvement.1 In recent years the application of plateletrich plasma to enhance bone regeneration and soft-tissue maturation has increased in

maxillofacial and orthopaedic surgery.3-7 Platelet α-granules contain over 30 growth factors. The most important are platelet-derived growth factor, transforming growth factor-β, vascular endothelial growth factor, insulin-like growth...