Strategies in Trauma and Limb Reconstruction

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VOLUME 9 , ISSUE 3 ( November, 2014 ) > List of Articles

Original Article

Adjuvant treatment of chronic osteomyelitis of the tibia following exogenous trauma using OSTEOSET®-T: a review of 21 patients in a regional trauma centre

Gemma Humm, Saqib Noor, Philippa Bridgeman, Michael David, Deepa Bose

Keywords : Osteomyelitis, Tibia, Trauma, Osteoset, Antibiotic

Citation Information : Humm G, Noor S, Bridgeman P, David M, Bose D. Adjuvant treatment of chronic osteomyelitis of the tibia following exogenous trauma using OSTEOSET®-T: a review of 21 patients in a regional trauma centre. 2014; 9 (3):157-161.

DOI: 10.1007/s11751-014-0206-y

License: CC BY-NC-SA 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Surgical debridement and prolonged systemic antibiotic therapy are an established management strategy for infection after tibial fractures. Local antibiotic delivery via cement beads has shown improved outcome but requires further surgery for extraction of beads. OSTEOSET®-T is a resorbable bone void filler composed of calcium sulphate and 4 % tobramycin that is packed easily into bone defects. This is a review of the outcomes of 21 patients treated with OSTEOSET®-T for osteomyelitis of the tibia. This is a retrospective case note and clinical review. In all cases, the strategy was debridement, with removal of any implants, with excision back to bleeding bone. OSTEOSET®-T pellets were packed into any contained defects or the intra-medullary canal with further bony stabilisation (n = 9) and soft tissue reconstruction (n = 7) undertaken as required. Intravenous vancomycin and meropenem were administered after sampling with substitution to targeted antibiotic therapy for between 6 weeks and 6 months. The average follow-up was 15 months. Union rate after tibial reconstruction was 100 %. Wound complications were encountered in 52 %: a wound discharge in the early post-operative period was noted in seven patients (33 %) independent of site of pellet placement. In the 14 cases without a wound leak, five developed wound complications (p = 0.06, Fisher's exact test) either from delayed wound-healing or pin-site infections. One patient developed a transient acute kidney injury and one refractory osteomyelitis. OSTEOSET®-T is an effective adjunct in the treatment of chronic tibial osteomyelitis following trauma based on the low incidence of relapse of infection within the period of follow-up in this study, but significant wound complications and one transient nephrotoxic event were also recorded.


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  1. Struijs PA, Poolman RW, Bhandari M (2007) Infected nonunion of the long bones. J Orthop Trauma 21(7):507-511
  2. Wright Medical Technology Inc (2006) OSTEOSET®-T: medicated bone graft substitute technical monograph. http://www.ossano.se/Produkter/Bensubstitut/Osteoset/651-1097%20R5.06%20OSTEOSET%20T%20Tech%20Monograph.pdf. Accessed 15 Dec 2014
  3. Tay BK, Patel VV, Bradford DS (1999) Calcium sulfate- and calcium phosphate-based bone substitutes. Mimicry of the mineral phase of bone. Orthop Clin North Am 30(4):615-623
  4. Wahl P, Livio F, Jocobi M, Gautier E, Buclin T (2011) Systemic exposure to tobramycin after local antibiotic treatment with calcium sulphate as carrier material. Arch Orthop Trauma Surg 131:657-662
  5. Beardmore AA, Brooks DE, Wenke JC, Thomas DB (2005) Effectiveness of local antibiotic delivery with an osteoinductive and osteoconductive bone-graft substitute. J Bone Joint Surg Am 87(1):107-112
  6. Thomas BD, Brooks DE, Bice TG, DeJong ES, Lonergan KT, Wenke JC (2005) Tobramycin-impregnated calcium sulfate prevents infection in contaminated wounds. Clin Orthop Relat Res 441:366-371
  7. Tsai YH, Tsung-Jen H, Shih HN, Hsu RW (2004) Treatment of infected tibial nonunion with tobramycin-impregnated calcium sulfate: report of two cases. Chang Gung Med J 27(7):542-547
  8. Chang W, Colangell M, Colangell S, Di Bella C, Gozzi E, Donati D (2007) Adult osteomyelitis: debridement versus debridement plus Osteoset T® pellets. Acta Orthop Belg 73(2):238-243
  9. McKee M, Wild LM, Schemitsch EH, Waddell JP (2002) The use of an antibiotic-impregnated osteoconductive, bioabsorbable bone substitute in the treatment of infected long bone defects: early results of a prospective trial. J Orthopt Trauma 16(9):622-627
  10. Wright Medical Technology Inc (2011) OSTEOSET®: resorbable mini-bead kit. http://www.ossano.com/Produkter/Bensubstitut/Osteoset/SK409-511.pdf. Accessed 15 Dec 2014
  11. Rang HP, Dale MM, Ritter JM (1999) Rang, Dale and Ritter's pharmacology, 4th edn. Churchill Livingstone, New York
  12. Shakil S, Khan R, Zarrilli R, Khan A (2007) Aminoglycosides versus bacteria—a description of the action, resistance mechanism, and nosocomial battleground. J Biomed Sci 15(1):5-14
  13. Edson RS, Terrell CL (1999) The aminoglycosides. Mayo Clin Proc 74(5):519-528
  14. Bendush CL, Weber R (1976) Tobramycin sulfate: a summary of worldwide experience from clinical trials. J Infect Dis 134(Suppl): S219-S234
  15. Vuolo J (2004) Current options for managing the problem of excess wound exudate. Prof Nurse 19(9):487-491
  16. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE (1998) Role of rifampin for treatment of orthopedic implant-related Staphylococcal infections: a randomized controlled trial. Foreign- Body Infection (FBI) Study Group. JAMA 279:1537-1541
  17. Spellberg B, Lipsky B (2012) Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis 54(3):393-407
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