Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

General Orthopaedics

COMBINED DEAD SPACE MANAGEMENT AND PREVENTION OF INFECTION IN OPEN FRACTURES USING INTRAMEDULLARY NAIL IN ASSOCIATION WITH AN INJECTABLE ANTIBIOTIC-ELUTING COMPOSITE BONE SUBSTITUTE: A PRELIMINARY CASE SERIES

European Bone and Joint Infection Society (EBJIS), Nantes, France, September 2017



Abstract

Aim

Open fractures with bone defects and skin lesions carry a high risk of infection potentially leading to prolonged hospitalization and complication requiring revision procedures. Treatment options for diaphyseal fractures with soft tissue lesions are one- or two-stage approaches using external fixation or intramedullary nailing. We describe a surgical technique combining intramedullary nailing with an antibiotic-eluting biphasic bone substitute (BBS) applied both at the fracture site, for dead-space management and infection prevention, and on the nail surface for the prophylaxis of implant-related infection.

Method

Adult patients with an increased risk of bony infection (severe soft tissue damage and open fractures of Gustilo-Anderson grades I and II) were treated with debridement followed by application on the intramedullary nail surface, in the canal and at the fracture site of a BBS with prolonged elution (to 28 days) of either gentamicin or vancomycin. All patients also received systemic antibiotic prophylaxis following surgery. Data on infections and other adverse events were collected throughout the follow-up period. Bone union was determined by radiographic assessment of 4 cortices in radiographs obtained 1 year after surgery.

Results

In this prospective, non-randomized case series a total of 6 patients were treated: 4 tibia (2 male, 2 female), 1 femur (female) and 1 humerus (male). The mean age of the patients was 28 years (range 18–51 years). Two patients had a history of smoking and 1 patient had a history of diabetes. Minimal Follow up was 12 months (range: 12 – 30 months). One to two weeks postoperatively, partial load bearing (20 kg) was allowed with free mobility of joints. Bone samples from the fracture site following debridement showed the presence of bacteria in 2 cases. No infections were observed during follow-up. Radiographs showed that the bone substitute was resorbed and also a gradual bony union of the fractures. All patients had good clinical outcomes.

Conclusions

The addition of a BBS which elutes antibiotic locally in the dead-space of exposed fractures and at the implant surface prevents bacterial colonization and biofilm formation. The injectable composite we used enhances safety in higher risk patients, is easy to use in combination with intramedullary nailing and offers the opportunity for a one-stage procedure. Local administration of antibiotics at the fracture site provides an additional tool to manage difficult-to-treat complex fractures and implant-related infections. Larger studies are needed to confirm these results.

*CERAMENT G or V, BONESUPPORT AB


E-mail: