Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases

Abstract

We reviewed 1085 consecutive compound limb fractures treated in 914 patients at the University of Louisville over a nine-year period. Of these fractures, 240 (group 1) received only systemic antibiotic prophylaxis and 845 (group 2) were managed by the supplementary local use of aminoglycoside-polymethylmethacrylate (PMMA) beads. There were no significant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious wound irrigation, meticulous debridement and skeletal stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p < 0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type-IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adjuvant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures.

A New Nano-Platform for Drug Release via Nanotubular Aluminum Oxide

“…The size of the AMX molecule is ~0.8 nm [26], a reasonable size to enter and fill the 20 nm diameter pores and interstitial spaces in between the nanotubes. Preoperative oral administration of AMX has been proven to reduce the risk of implant failure [27,28], and local delivery of AMX during orthopedic surgery reduced the infections associated with open fractures [29], compound limb fractures [30], and with osteoinductive and osteoconductive bone-graft substitutes [29]. As well, local delivery of antibiotics was effective in reducing vascular infections from staphylococcal strains [31].…”

Lokale Antibiotikatherapie

“…Auch in der Unfallchirurgie wurde eine signifikante Reduktion der Inzidenz akuter Knocheninfektionen und Osteomyelitisfälle bei offenen Brüchen mit erheblicher Schädigung des Weichteilgewebes (Gustilo-Typ-IIIB-und -IIICFrakturen) beschrieben, wenn zusätzlich zum chirurgischen Débridement und zur systemischen Antibiotikaprophylaxe antibiotikabeladene Knochenzementketten vor Ort eingesetzt wurden [34,35,53,58].…”

Antibiotic Loaded Acrylic Bone Cement in Orthopaedic Trauma

“…Infection is the most dreaded complication of open fractures with higher Gustilo types having a higher incidence of this complication (Zalavras et al, 2005;Ostermann et al, 1995). Microbial growth in open fractures is enhanced by a variety of factors like impaired vascularity, devitalized bone and soft tissue, and loss of skeletal stability .It is now well recognized that integrity of soft tissue is essential for an uncomplicated course of fracture healing .…”

“…Microbial growth in open fractures is enhanced by a variety of factors like impaired vascularity, devitalized bone and soft tissue, and loss of skeletal stability .It is now well recognized that integrity of soft tissue is essential for an uncomplicated course of fracture healing . Current principles in the management of open fractures include wound irrigation, serial radical debridement, early systemic administration of a short course of broad-spectrum antibiotics, stabilisation of the bone and early soft-tissue coverage (Zalavras et al 2005;Ostermann et al, 1995). Prevention of infection is one of the main goals of open fracture management.…”

“…Therefore it can be said that antibiotics are not just for prophylaxis but rather for treatment of wound contamination per se (Zalavras et al 2005). The use of local antibiotics to achieve therapeutic tissue levels in target areas as an alternative to systemic route which requires high serum levels of potentially toxic and costly antibiotics is an attractive and viable option (Ostermann et al, 1995). Aminoglycosides are the most frequently chosen antibiotic because of their broad anti-bacterial spectrum, thermostability and low www.intechopen.com allergenicity (Zalavras et al 2005).…”