Osteomyelitis treatment with antibiotic cement-coated plate fixation. Two case reports

DOI: https://doi.org/10.15417/issn.1852-7434.2020.85.4.1004
Keywords: Osteomyelitis, antibiotic cement-coated plate, osteosynthesis failure

Abstract

Treatment of osteomyelitis associated with osteosynthesis failure represents a real challenge for the orthopedic surgeon. Implant removal, surgical debridement of the affected area, and external fixation as a temporary stabilization method coupled with antibiotic therapy administered by the systemic route constitute the basis for the initial management of infections associated with implant failure. However, this combined management may prove inadequate to achieve complete control of the infection. The local use of antibiotic-loaded cement allows for maintaining a sustained agent release that reaches significantly higher concentrations than the minimum required bacterial inhibitory concentrations while reducing the associated systemic toxicity. We present two cases of osteomyelitis associated with osteosynthesis failure treated with a second osteosynthesis procedure with an antibiotic cement-coated plate. Infection control and bone union were achieved in both cases. The functional outcome was excellent with Quick-DASH scores of 6.3 and 4.5 points, respectively. Key words: Osteomyelitis; antibiotic cement-coated plate, osteosynthesis failure.Level of Evidence: IV

Downloads

Download data is not yet available.

Author Biographies

Jorge Luis Soutullo, Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular (Buenos Aires, Argentina)
Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular(Buenos Aires, Argentina)
Santiago Argüelles, Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular (Buenos Aires, Argentina)
Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular(Buenos Aires, Argentina)
Martín Pablo Rodríguez, Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular (Buenos Aires, Argentina)
Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular(Buenos Aires, Argentina)
Enrique Pereira, Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular (Buenos Aires, Argentina)
Hand and Upper Limb Team, Instituto de Tratamiento y Rehabilitación Articular(Buenos Aires, Argentina)

References

Krüger-Franke M, Carl C, Haus J. [Treatment of infected intramedullary osteosynthesis. A comparison of various therapeutic procedures]. Aktuelle Traumatol 1993;23(2):72-6. [En alemán] PMID: 8098574

Evans RP, Nelson CL. Gentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis. Clin Orthop Relat Res 1993;(295):37-42. PMID: 8403668

Pelissier Ph, Masquelet AC, Bareille R, Mathoulin Pelissier S, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22(1):73-9. https://doi.org/10.1016/S0736-0266(03)00165-7

Rutledge B, Huyette D, Day D, Anglen J. Treatment of osteomyelitis with local antibiotics delivered via

bioabsorbable polymer. Clin Orthop Relat Res 2003;(411(:280-7. https://doi.org/10.1097/01.blo.0000065836.93465.ed

Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res 2004;(427):86-93. https://doi.org/10.1097/01.blo.0000143571.18892.8d

Mader JT, Stevens CM, Stevens JH, Ruble R, Lathrop JT, Calhoun JH. Treatment of experimental osteomyelitis

with a fibrin sealant antibiotic implant. Clin Orthop Relat Res 2002;(403):58-72.

https://doi.org/10.1097/00003086-200210000-00011

Adams K, Couch L, Cierny G, Calhoun J, Mader JT. In vitro and in vivo evaluation of antibiotic diffusion from

antibiotic impregnated polymethylmethacrylate beads. Clin Orthop 1992;(278):244-52. PMID: 1563160

Penner MJ, Masri BA, Duncan CP. Elution characteristics of vancomycin and tobramycin combined in acrylic bonecement. J Arthroplasty 1996;11(8):939-44. https://doi.org/10.1016/s0883-5403(96)80135-5

Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current

management concepts. J Am Acad Orthop Surg 2005;13(6):417-27. https://doi.org/10.5435/00124635-200510000-00006

Bistolfi A, Massazza G, Verne E, Massè A, Deledda D, Ferraris S, et al. Antibiotic-loaded cement in orthopedic

surgery: a review. ISRN Orthop 2011;2011:290851. https://doi.org/10.5402/2011/290851 10.5402/2011/290851

Kusy RP, Whitley JQ, Kalachandra S. Mechanical properties and interrelationships of poly(Methyl Methacrylate) following hydration over saturated salts. Polymer 2001;42(6):2585-95.

https://doi.org/10.1016/S0032-3861(00)00613-3

Ayre WN, Denyer SP, Evans SL. Ageing and moisture uptake in polymethyl methacrylate (PMMA) bone cements. J Mech Behav Biomed Mater 2014;32(100):76-88. https://doi.org/10.1016/j.jmbbm.2013.12.010

Ohtsuka H, Yokoyama K, Higashi K, Tsutsumi A, Fukushima N, Noumi T, et al. Use of antibiotic-impregnated bone cement nail to treat septic nonunion after open tibial fracture. J Trauma 2002;52(2):364-6.

https://doi.org/10.1097/00005373-200202000-00025

Norden CW. Experimental osteomyelitis. I. A description of the model. J Infect Dis 1970;122(5):410-8.

https://doi.org/10.1093/infdis/122.5.410

Madanagopal SG, Seligson D, Roberts CS. The antibiotic cement nail for infection after tibial nailing. Orthopedics 2004;27(7):709-12. PMID: 15315038

Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and

segmental bone defects. J Orthop Trauma 2007;21(4): 258-68. https://doi.org/10.1097/BOT.0b013e31803ea9e6

Liporace FA, Yoon RS. Use of an “antibiotic plate” for infected periprosthetic fracture in total hip arthroplasty. J Orthop Trauma 2012;26(3):e18-e23. https://doi.org/10.1097/BOT.0b013e318216dd60

Conway JD, Hlad LM, Bark SE. Antibiotic cement-coated plates for management of infected fractures. Am J

Orthop (Belle Mead NJ) 2015;44 (2):E49-E53. PMID: 25658083

Published
2020-11-18
How to Cite
Soutullo, J. L., Argüelles, S., Rodríguez, M. P., & Pereira, E. (2020). Osteomyelitis treatment with antibiotic cement-coated plate fixation. Two case reports. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4), 403-417. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1004
Issue
Vol 85 No 4 (2020)
Section
Case Presentations
Copyright (c) 2020 Revista de la Asociación Argentina de Ortopedia y Traumatología

Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.

In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.

It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.

The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.