Antibiotic concentration in infected bone is a major determinant of clinical response. As glycopeptides and fluoroquinolones are widely used for the treatment of bone infections, aim of our study was to assess their diffusion in infected human bone. Patients with a posttraumatic septic pseudoarthrosis undergoing debridement of infected tissue, who received a glycopeptide or a fluoroquinolone for > 1 week, were studied. Plasma and bone specimens were collected intraoperatively for phamacokinetic and microbiologic assays at a mean of 4.1h after antibiotic administration. Bone samples were crushed and concentrations were measured by HPLC-UV method. Overall plasma exposure was also determined with daily sampling. 16 patients were studied. 6 patients received iv vancomycin 1 g bid over a 1-hr infusion Bone cultures grew E. faecalis, MRSA and MRSE (MIC < 2 mg/L). Mean plasma concentration of vancomycin at time of osteotomy was 19.8 mg/L. Mean bone concentrations were 2.4 mg/L in cortical and 7.1 mg/L in cancellous bone, with a mean bone extraction of 12 % and 36 %, respectively. 4 patients were treated with iv teicoplanin 10/mg/Kg for MRSA infection (MIC < 2 mg/L). Mean bone concentrations were 8.9 mg/L and 37 mg/l respectively for cortical and cancellous bone, respectively corresponding to 6% and 25% of plasma levels. Six patients were treated with a fluoroquinolone. 3 patients received iv ciprofloxacin 400mg bid and E. coli grew from bone samples(MIC = 0.5 mg/L). Mean Plasma concentration of ciprofloxacin at the time of osteotomy was 3.6 mcg/mL. Mean bone concentrations were 1.7 mg/L in cortical bone and 30.2 mg/L in cancellous and newly formed bone, with respective bone/ plasma ratios of 0.5 and 8.4. 3 patients were administered iv levofloxacin 500mg qd and Enterobacter spp. were isolated (MIC = 1 mg/L). Mean plasma concentration at the time of surgery was 2.5 mcg/mL. Mean bone concentrations were 0.3 and 2.69 mcg/mL in cortical and cancellous bone, respectively. To our knowledge this is the first study that compares different antibiotic’s concentration in infected bone with the same dosing procedure. Both vancomycin and teicoplanin provided mean bone concentrations exceeding the susceptibility breakpoint of the infecting agents. Higher and constant glycopeptides plasma levels may be required for preventing recurrencies in bone infections. Only ciprofloxacin provided cortical bone concentrations higher than the susceptibility breakpoint of the infecting agent, and similar to those reported in non-infected bone. Ciprofloxacin concentration in cancellous bone and in bony callus were far higher than those detected in plasma, which may be related to an augmented vascularization and/or selective accumulation of fluoroquinolones into regenerating bone, as observed in children’s cartilage growth plate. Ciprofloxacin may be therefore preferred to levofloxacin.

BACKGROUND and AIM: There is no consensus on the best treatment for acute Achilles tendon ruptures. There is no single, uniformly accepted surgical technique, and the surgical options include open repair with or without augmentation and percutaneous techniques. A retrospective analysis was conducted to compare different surgical procedures for the treatment of the rupture of the achilles tendon.

PATIENTS and METHODS: from october 2002 to september 2006, 176 patients (male 155 and female 21) underwent surgical procedures: 105 open repair (Kessler, Barbed wire) and 71 percutaneous repair (Ma Griffith, Tenolig, Bio-tex).132 patients were evaluated, including criteria was a minimal follow-up of six months;; all patients were interwieved, 81 were assesed with physical examination using Kitaoka rating score and 44 also with isokinetic dynamometer test (Kintrex) measuring strenght, power and endurance.

RESULTS: The mean surgical time was 53.5 minutes with the open repair and 28,6 minutes in closed procedure. All the closed procedures were performed in regional anesthesia and did not required hospitalization. Objective and functional assessement and the isokinetic test showed no statistically significant difference between the two groups (p< 0.05). All patients return to pre-injury working and recreational sport activities. At the physical examination 47 patients showed an important (more than 2 cm) reduction of calf circumference. In the open group there were no rerupture, one deep infection, 10 painful or ipertrophic scars. Complication in the percutaneous repair included 3 reruptures (2 patients fell few days after surgery), no wound infections, 3 disturbances in sensitivity of the sural nerve.

CONCLUSION: On the basis of these results, the percutaneous repair as suitable alternative to open techniques may be recommended. This is a simple and safe surgical procedure which allows to achieve an high rate of excellent functional outcomes with minimal morbidity. Furthermore the time for surgery is shorther and the procedure can be performed without hospitalization.