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VOLUME 13 , ISSUE 1 ( April, 2018 ) > List of Articles

Original Article

A novel treatment approach to infected nonunion of long bones without systemic antibiotics

Karim Z. Masrouha, Michael E. Raad, Said Saghieh

Keywords : Infection, Nonunion, Local antibiotics, Calcium sulphate, Bone pellet, Long bones

Citation Information : Masrouha KZ, Raad ME, Saghieh S. A novel treatment approach to infected nonunion of long bones without systemic antibiotics. 2018; 13 (1):13-18.

DOI: 10.1007/s11751-018-0303-4

License: CC BY-NC-SA 4.0

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Infected nonunion of long bones may require intravenous antibiotics over a lengthy period which may result in a high rate of complications. This study aims to assess the efficacy of local antibiotics used as a replacement to prolonged intravenous therapy. Thirteen patients with infected nonunion of long bones who failed at least one previous surgery were included. The infection was treated through extensive debridement, application of antibiotic-impregnated calcium sulphate pellets and the bone stabilized with external fixation. These patients were monitored for union and infection by clinical signs, laboratory values, and radiographs over a period of 24 months. The results support an eradication of infection and union in all patients with no antibiotic-associated complications. Local antibiotic delivery using calcium sulphate pellets provides an effective method for treatment of nonunion in long bones and is free of the complications from the intravenous route.


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  1. Bose D, Kugan R, Stubbs D, McNally M (2015) Management of infected nonunion of the long bones by a multidisciplinary team. Bone Joint J 97B(6):814-817. https://doi.org/10.1302/0301-620X.97B6.33276
  2. Antonova E, Le TK, Burge R, Mershon J (2013) Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord 14:42. https://doi.org/10.1186/1471-2474-14-42
  3. Fraimow HS (2009) Systemic antimicrobial therapy in osteomyelitis. Semin Plast Surg 23(2):90-99. https://doi.org/10.1055/s-0029-1214161
  4. Lazzarini L, Lipsky BA, Mader JT (2005) Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 9(3):127-138. https://doi.org/10.1016/j.ijid.2004.09.009
  5. Gogia JS, Meehan JP, Di Cesare PE, Jamali AA (2009) Local antibiotic therapy in osteomyelitis. Semin Plast Surg 23(2):100-107. https://doi.org/10.1055/s-0029-1214162
  6. Cheung E, Baerlocher MO, Asch M, Myers A (2009) Venous access: a practical review for 2009. Can Fam Physician 55(5):494-496
  7. Marculescu CE, Berbari EF, Cantey JR, Osmon DR (2012) Practical considerations in the use of outpatient antimicrobial therapy for musculoskeletal infections. Mayo Clin Proc 87(1):98-105. https://doi.org/10.1016/j.mayocp.2011.11.005
  8. Paladino JA, Poretz D (2010) Outpatient parenteral antimicrobial therapy today. Clin Infect Dis 51(S2):S198-208. https://doi.org/10.1086/653520
  9. Van Hal SJ, Paterson DL, Lodise TP (2013) Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 57(2):734-744. https://doi.org/10.1128/AAC.01568-12
  10. Neut D, van de Belt H, Stokroos I, van Horn JR, van der Mei HC, Busscher HJ (2001) Biomaterial-associated infection of gentamicin- loaded PMMA beads in orthopaedic revision surgery. J Antimicrob Chemother 47(6):885-891. https://doi.org/10.1093/jac/47.6.885
  11. Gauland C (2011) Managing lower-extremity osteomyelitis locally with surgical debridement and synthetic calcium sulphate antibiotic tablets. Adv Skin Wound Care 24(11):515-523. https://doi.org/10.1097/01.ASW.0000407647.12832.6c
  12. Mader JT, Shirtliff M, Calhoun JH (1997) Staging and staging application in osteomyelitis. Clin Infect Dis 25(6):1303-1309
  13. Ilizarov GA, Ledyaev VI (1992) The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop Relat Res 280:7-10
  14. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, Schemitsch EH (2010) Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 68(3):629-632. https://doi.org/10.1097/TA.0b013e3181a7c16d
  15. Smilack JD, Flittie WH, Williams TW Jr (1976) Bone concentrations of antimicrobial agents after parenteral administration. Antimicrob Agents Chemother 9(1):169-171
  16. Gitelis S, Brebach GT (2002) The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant. J Orthop Surg (Hong Kong) 10(1):53-60
  17. Struijs PA, Poolman RW, Bhandari M (2007) Infected nonunion of the long bones. J Orthop Trauma 21(7):507-511. https://doi.org/10.1097/BOT.0b013e31812e5578
  18. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG, Jr Singh J (2012) Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma 26(3):184-188. https://doi.org/10.1097/BOT.0b013e318225f77c
  19. McConoughey SJ, Howlin RP, Wiseman J, Stoodley P, Calhoun JH (2015) Comparing PMMA and calcium sulphate as carriers for the local delivery of antibiotics to infected surgical sites. J Biomed Mater Res B Appl Biomater 103(4):870-877. https://doi.org/10.1002/jbm.b.33247
  20. Ferguson JY, Dudareva M, Riley ND, Stubbs D, Atkins BL, McNally MA (2014) The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases. Bone Joint J 96-B(6):829-836. https://doi.org/10.1302/0301-620x.96b6.32756
  21. Gruber R, Koch H, Doll BA, Tegtmeier F, Einhorn TA, Hollinger JO (2006) Fracture healing in the elderly patient. Exp Gerontol 41(11):1080-1093. https://doi.org/10.1016/j.exger.2006.09.008
  22. Ciampolini J, Harding KG, Pathophysiology of chronic bacterial osteomyelitis (2000) Why do antibiotics fail so often? Postgrad Med J 76(898):479-483. https://doi.org/10.1136/pmj.76.898.479
  23. Ceroni D, Regusci M, Pazos JM, Saunders CT, Kaelin A (2003) Risks and complications of prolonged parenteral antibiotic treatment in children with acute osteoarticular infections. Acta Orthop Belg 69(5):400-404
  24. Cierny G 3rd, DiPasquale D (2006) Treatment of chronic infection. J Am Acad Orthop Surg 14(10):S105-110. https://doi.org/10.5435/00124635-200600001-00025
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