Aim. We describe a case series using adjuvant calcium sulphate bio composites with antibiotics in treating infected metalwork in the foot and ankle. Method. 11 patients aged 22–81 (9 males, 2 females) were treated with clinical evidence of infected limb metal work from previous orthopaedic surgery. Metal work removal with intra osseous application of either cerement in 8 cases (10–20ml including 175mg–350mg gentamycin) or stimulan in 3 cases (5–12ml including 1g vancomycin) into the site was performed. Supplemental systemic antibiotic therapy (oral/intravenous) was instituted based on intraoperative tissue culture and sensitivity. Results. 7 patients had infected ankle metalwork, 2 had infected foot metalwork and 2 had infected external fixators. Metal work was removed in all cases. Mean pre operative CRP was 25.4 mg/l (range 1–137mg/l). Mean postoperative CRP at 1 week was 15.4mg/l (range 2–36mg/l) and at 1 month was 16.1mg/l (range 2–63mg/l). Mean pre op WCC was 8.5×10. 9. (range 6.2–10.6×10. 9. ). Mean post op WCC at 1 week was 8.8×10. 9. (range 5.1–12.7×10. 9. ) and 1 month was 7.1×10. 9. (range 3.7–10.4×10. 9. ). Organisms cultured included enterobacter, staphylococcus species, stenotrophomonas, acinetobacter, group B streptococcus, enterococcus, escherichia coli, pseudomonas, morganella morganii and finegoldia magna. Infection eradication as a single stage procedure with primary would closure and healing was achieved in 10 out of 11 cases (90.9%). No additional procedures were required in these cases. Conclusions. Our results support the use of a calcium sulphate bio composite with antibiotic as an adjuvant for effective local infection control in cases with implant related bone sepsis. The technique is well tolerated with no systemic or local side effects. Our results show that a single stage implant removal, debridement and local antibiotic delivery can achieve over 90% success rates. We theorise that it could minimise the need for prolonged systemic antibiotic therapy in such cases

Background. Diabetes is bad, common and diabetic foot ulcers (DFU) once established lead to high rates of amputation. In Nottingham our standard management for infected diabetic foot ulcers is surgical debridement, microbiological sampling, packing with gentamicin beads and targeted antibiotic therapy. Recently we have switched to packing with Stimulan, which is a purified synthetic calcium sulphate compound that can be mixed with patient appropriate antibiotics, is biodegradable and delivers better elution characteristics compared to gentamicin beads. Aim. To assess the efficacy of Stimulan compared to Gentamicin beads in the surgical management of infected diabetic foot ulcers. Methods. In 2012/13 the department audited its results of DFU surgical management with gentamicin beads. In 2014/5 the audit was repeated but Stimulan was used instead due to the perceived advantages Patients with infected DFU that could comply with treatment were included. Patients who had other sources of sepsis, non-compliant or moribund were excluded. Treatment pathways were identical apart for the use of Stimulan in 2014/5. The primary outcome measure was ulcer healing. The secondary outcome measure was length of stay and recurrence. Results. Each group had 23 patients. The gentamicin group had a DFU for 12.3 months(3weeks-5 years) before presentation for surgery compared to the Stimulan group 6.1 months(2weeks-5years). Both groups had failed non-surgical management. The majority of the ulcers were located on the forefoot. In the stimulan group 70% (16/23) of ulcers had healed with an average of 4 months(2–7 months) compared to 57% (13/23) in the Gentamicin group within 6months(1–12). The length of stay was shorter in the Stimulan group 7 days (1–70) compared to 28days(1–70) in the Gentamicin group. Conclusion. In our review Stimulan was superior to Gentamicin beads in the management of infected diabetic foot ulcers. We believe it has a role to play in limb salvage

Aims

In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method.