LOQTEQ® Antibacterial Pre-Market Study

Antimicrobial coatings of implants are of interest to reduce infection rate in orthopaedic surgery. Demonstration of clinical effectiveness of such coated implants to obtain market approval is challenging. The objective of this article is to define a design for a randomized controlled trial to evaluate the clinical performance of a silver-coating for locking plates for fracture treatment.

The study design has to respect different criteria, such as feasibility, focus on overall complications, such as functional impairment, fracture healing and infection rates. The study design was defined as randomized, controlled, subject-blinded, multi-center study in subjects with fractures of the distal fibula with a total of 184 patients. A number of 92 patients are planned for each of the two treatment arms with treatment of the fracture with a silver-coated device (first arm) or with an uncoated device (second arm). Inclusion criteria are closed and open fractures of the distal fibula with Gustilo-Anderson type I to Gustilo-Anderson type IIIB type older than 18 years. Primary outcome parameter is the Anticipated Adverse Device Effects (AADE) including all typical complications of this type of injury, such as functional impairment of the affected limb, non-union and infections based on a non-inferiority study design. Also, silver-typical complications, such as argyria, are included. Secondary parameters are infection rates and fracture healing. Follow-up of patients includes five visits with clinical and X-ray evaluations with a follow-up time of 12 months.

Inclusion criteria

• Able and willing to provide voluntary written Informed Consent prior to any study related procedure.
• Subject aged 18 years and over.
• Subjects with fractures of the distal fibula.

Exclusion criteria

• Subject unable to give written informed consent, is unlikely to cooperate or is legally incompetent.
• Subjects with consumptive / malignant primary disease and a life expectancy of less than 12 months.
• Subjects with a known allergy to silver or any components of the device.
• Subjects with an already implanted silver-coated device other than the investigational device.
• History of or ongoing chronic soft-tissue and/or bone and/or implant infection signs at the distal tibia and/or distal fibula (not related to current fracture).
• Subjects with a possible contraindication for the investigational and comparator devices

• infection or inflammation requiring treatment with antibiotics or with positive cultures (not related to current fracture);
• acute and chronic osteomyelitis at or close to the surgical field (not related to current fracture);
• high anesthesia risk subjects (ASA Physical Status Classification of 4 to 6);
• subjects with neurological disorders who cannot follow instructions given by their physician;
• subjects with past history of severe medical disorders of extremity which may impact study device efficacy and safety according to investigator's judgment;
• severe chronic or acute comorbidity according to investigator's judgement (such as arthritis or neurogenic disorders).
• Female subjects who are pregnant or lactating at Screening Visit.
• Females who are of childbearing potential and not taking adequate contraceptive precautions are excluded from the trial. Females of childbearing potential taking acceptable contraceptive precautions according to investigator's judgement can be included.
• Males with partners who are pregnant or lactating or of childbearing potential and are unwilling to use condoms for the duration of the study. Males who are unable or unwilling to use condoms can be included if partners of childbearing potential taking acceptable contraceptive precautions according to investigator's judgement.
• Participation in any other study involving an investigational drug or device currently or within the past 3 months.
• Subject has a significant history of drug/solvent abuse.
• Subject has a history of alcohol abuse or currently drinks more than 224 g alcohol for men and 112 g alcohol for women per week.
• Subjects with stage IV vascular disease, i.e. with presence of necrotic tissue at the distal tibia.