Osteomyelitis treatment with antibiotic cement-coated plate fixation. Two case reports
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Published:
Nov 18, 2020
Keywords:
Osteomyelitis, antibiotic cement-coated plate, osteosynthesis failure
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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
Key words: Osteomyelitis; antibiotic cement-coated plate, osteosynthesis failure.Level of Evidence: IV
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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
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Case Presentations
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References
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https://doi.org/10.1097/00005373-200202000-00025
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https://doi.org/10.1093/infdis/122.5.410
15. Madanagopal SG, Seligson D, Roberts CS. The antibiotic cement nail for infection after tibial nailing. Orthopedics 2004;27(7):709-12. PMID: 15315038
16. 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
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Orthop (Belle Mead NJ) 2015;44 (2):E49-E53. PMID: 25658083
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. Madanagopal SG, Seligson D, Roberts CS. The antibiotic cement nail for infection after tibial nailing. Orthopedics 2004;27(7):709-12. PMID: 15315038
16. 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
17. 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
18. 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