To study the clinical, radiological and functional outcome of antibiotic mixed cement coated nails in infected long bone diaphyseal fractures
Abstract
Background: In Present Era, High velocity trauma are common trends leading to compound long bone fractures. These fractures have high chance of infection which further leads to infected non-union. Traditionally multistage procedure such as debridement and systemic antibiotics with temporary fixation and then permanent fixation and bone grafting when required. Single staged procedures such as debridement and application of Ilizarov fixator and limb reconstruction system are also available. Recently, development ofinfection control by local antibiotic delivery systems, initially antibiotic cement beads then antibiotic cement impregnated intramedullary nail (ACIINs).The aim of this study is to analyze clinical, functional and radiological outcome of antibiotic mixed cement coated nailing in infected long bone diaphyseal fractures.
Material and Methods: In our prospective study, 20 patients of 17-70 years of age group with infected long bone diaphyseal fractures were treated using antibiotic mixed cement coated intramedullary nails. The outcome of study was analyzed for infection control, radiological sign of union, ability to bear weight and patient compliance.
Results: In our study, we achieved infection control in 95% of patients with complete radiological union in 50% of cases with ability to bear weight without pain.
Conclusion: Antibiotic Mixed Cement Coated Nailing was a good procedure to achieve infection control, provide stability and bone union in infected long bone fractures.
Downloads
References
2. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005;13(6):417–27. [PubMed]
3. Court-Brown CM. Fractures of the tibia and fibula. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green's fractures in adults. 6th ed. Lippincott Williams and Wilkins; 2006. p. 2080-146.
4. Young S, Lie SA, Hallan G, Zirkle LG, Engesæter LB, Havelin LI. Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low- and Middle-income Countries. World J Surg. 2013;37(2):349–55.
5. Gianluca Giavaresi, Veronica Borsari, Milena Fini, Roberto Giardino, Vittorio Sambri, Paolo Gaibani, Renzo Soffiatti. Preliminary Investigations on a New Gentamicin and Vancomycin-Coated PMMA Nail for the Treatment of Bone and Intramedullary Infections: An Experimental Study in the Rabbit.. DOI 10.1002/jor.20543.
6. Ueng SW, Chuang DC, Cheng SL, Shih CH. Management of large infected tibial defects with radical debridement and staged double-rib composite free transfer. J Trauma 1996;40:345-9.
7. Qiang Z, Jun PZ, Jie XJ, Hang L, Bing LJ, Cai LF. Use of antibiotic cement rod to treat intramedullary infection after nailing: Preliminary study in 19 patients. Arch Orthop Trauma Surg 2007; 127:945-51. [PubMed]
8. Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected non-unions and segmental bone defects. J Orthop Trauma 2007;21:258-68.
9. Rajesh dhanasekhar et al. Antibiotic cement impregnated nailing in management of infected non union of femur and tibia :Kerala J Orthop 2013; 26:93-97.
10. Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. 2004;427: 8693. [PubMed]
11. Wininger DA, Fass RJ. Antibiotic-impregnated cement and beads for orthopedic infections. Antimicrob Agents Chemother 1996;40:2675-9. [PubMed]
12. Buchholz HW, Elson RA, Heinert K. Antibiotic-loaded acrylic cement: Current concepts. Clin Orthop Relat Res 1984;190:96-108. [PubMed]
13. Henry SL, Ostermann PA, Seligson D. The prophylactic use of antibiotic impregnated beads in open fractures. J Trauma. 1990;30:1231-8.
14. Blaha JD. Calcium sulfate bone void filler. Orthopaedics 1998;21:1017-9. [PubMed]
15. HanssenAD. Local antibiotic delivery vehicle in the treatment of musculoskeletal infection. Clin Orthop 1994;298:229-39. [PubMed]
16. Heijinkl A, Yeszemski MJ, Patel R, Rouse MS, Lewallen DG, Hanssen AD, Local antibiotic delivery with Osteoset, DBX,and Collagraft. Clin orthop 2006;451:29-33
17. Nelson CL, MacLaren SG, Skinner RA, SmeltzerMS, Thomas JR, Olsen KM. The treatment of experimental osteomyelitis by surgical debridement and the implantation of calcium sulfate tobramycin pellets. J Orthop Res 2002;20:643-7.
18. Springer BD, Lee GC, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ. Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res 2004;427:47-51.
19. Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC, et al. Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty 2001;16:882-92. [PubMed]
20. Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: Preliminary results in nine cases. J Orthop Trauma 2002;16:723-9. [PubMed]
21. Madanagopal SG, Seligson D, Roberts CS. The antibiotic cementnail for infection after tibial nailing. Orthopedics 2004;27:709-12.