Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

Abstract

Background. Longbone infected bone defect remains a great challenge due to multiple surgeries, long-term treatment duration, and uncertain prognosis. Treatment principles include eradication/debridement, stabilization, and antibiotic administration. An antibiotic cement-coated nail has shown great prospects due to both local antibiotic elution and stabilization of bone defects. However, the current fabrication technique remains to be improved. Methods. For the first time, we described a new method for custom-made cement-coated nail fabrication based on a 3D printing technique. A retrospective study of 19 consecutive patients with long bone infected bone defects from one medical center was conducted who met the inclusion and exclusion criteria from November 2016 to May 2020. The treatment involved thorough debridement, custom-made antibiotic cement-coated nail filling, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Clinical and radiographic examinations (X-ray and CT scans) were used to evaluate bony union. Clinical and laboratory examinations were used to evaluate the infection control. The SF-36 score was used to evaluate patients’ quality of life pre- and postoperatively. Results. The mean follow-up was 98.8 weeks (ranging from 40 to 192). All cases achieved infection control, 3 cases achieved bone healing after one-stage operation, and 12 cases achieved bone healing after a two-stage bone graft procedure. At the last follow-up, none of the 19 patients had infection recurrence or 1 case had failure of the protective plate. The pre- and postoperative SF-36 score showed that there were statistical differences in all the 9 aspects. Conclusions. The precise custom-made antibiotic cement-coated intramedullary nail through the 3D printing technique used in this study is an effective strategy for the treatment of infected bone defects of long bone. This technique may help to increase the infection control rate and promote bone healing.

Recent advances in the local antibiotics delivery systems for management of osteomyelitis

“…Clinical studies on local delivery of antibiotics along with the delivery vehicle that contains bone filling materials for the treatment of long bone infections are also available. They have been proven very effective in: (1) early suppression of infection, (2) showing several-folds reduction in the recurrent infection incidence, (3) minimizing the risk of pathological fracture due to internal reinforcement, (4) providing early recovery of extremity’s function and (5) creation of favorable conditions for bone structures restoration (Dzyuba et al., 2016 ; Mauffrey et al., 2016 ; Wang et al., 2021 ). The highlighted advantages of some cements being biodegradable and their ability to sustain the release of antibiotics over weeks of recovery period have greatly encouraged its widespread.…”

“…In a clinical study published by Wang et al. ( 2021 ), 19 patients diagnosed with chronic osteomyelitis in long bones underwent debridement procedure to remove the dead tissues followed by implanting a 3 D printed intramedullary titanium nail coated with PMMA impregnated with antimicrobial agents. Procedure involved formation of the 3 D molds that simulates the defect areas followed by using titanium nails coated by PMMA and vancomycin/imipenem to fit the molds.…”

“…Different techniques were employed for scaffold fabrication and application to the affected parts of bones either in animal studies and/or in clinical trials, including topical implantation of the compounded system (Singh et al., 2020 ; Fang et al., 2021 ), in situ forming implant of an injectable system (Wasupalli & Verma, 2020 ; Moeinzadeh et al., 2021 ) and three-dimensional (3 D) printing of a fitting system (Sun et al., 2021 ; Wang et al., 2021 ). Graphical presentation of the application methods of scaffolds loaded with antibiotics into the infected bone tissues are shown in Figure 2 .…”

The Antibacterial Effect, Biocompatibility, and Osteogenesis of Vancomycin-Nanodiamond Composite Scaffold for Infected Bone Defects

“… 15 , 16 Therefore, to control existing infections effectively and prevent possible infections, it is necessary to fill and repair bone defects using drugs that inhibit the growth and reproduction of pathogenic bacteria in the bone defect. 17 Composite bone graft substitute materials with osteogenic activity and local anti-infective ability to construct a local drug delivery system (DDS) can continuously provide an effective drug concentration in the infected area. Meanwhile, the blood drug concentration is low, which cannot easily cause severe systemic toxicity and side effects.…”

Current research progress of local drug delivery systems based on biodegradable polymers in treating chronic osteomyelitis

“…The application of bone cement loaded with antibiotics has been demonstrated as an efficient and commonly used strategy for treating infectious osteomyelitis due to the following advantages: 1) effective infection suppression in the early stage, 2) noticeable reduction in the incidence of recurrent infection, 3) decreasing the occurrence of pathological fracture caused by internal reinforcement, 4) suitable for bone regeneration ( Dzyuba et al, 2016 ; Mauffrey et al, 2016 ; Wang et al, 2021 ). The most widely used bone cement material is poly(methyl methacrylate) (PMMA) beads with mixed antibiotics before surgery ( Gogia et al, 2009 ), it offers high concentrations of antibiotics at the lesion site without causing hypersensitivity reactions ( Lalidou et al, 2014 ) and is the gold standard of local delivery therapy for osteomyelitis ( Mohanty et al, 2003 ).…”