Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

Abstract

IntroductionThe vascularity of surrounding soft tissues, which is related to muscle cover, is important for the healing of traumatic bone loss. Muscle cover on the distal tibia is limited compared to the diaphyseal and proximal tibia, and delayed healing of fractures in this area is common. We evaluated the healing of traumatic bone loss in the proximal, diaphyseal, and distal tibia.Patients and methods 23 open tibial fractures with substantial bone loss (mean 52 (34-104) mm) were treated using a staged method with antibiotic-impregnated beads and later autologous bone grafting at second-stage surgery on average 8 weeks after the injury.Results 22 fractures healed after mean 40 (20-79) weeks. The average healing time in the distal tibia (mean 30 weeks) was 7 weeks shorter (95% CI: 12-26 weeks) than in the proximal tibia (37 weeks), and 16 weeks shorter (95% CI: 3-29 weeks) than in the tibial shaft (47 weeks). The length of the bone and the type of soft tissue cover (free muscle or secondary suture) had no effect on healing time.Interpretation Our study suggests that the method we used is applicable in all parts of the tibia, although the healing of bone loss is slower in the diaphyseal tibia than in the proximal and distal tibia.

Dual-Purpose Bone Grafts Improve Healing and Reduce Infection

“…1 In practice, poly(methyl methacrylate) (PMMA) cement beads have been used as the local antibiotic delivery platform, which has been shown to decrease infection in a number of clinical studies. 2 However, PMMA is nonbiodegradable and must be removed during a second surgical step before grafting and cannot be allowed to remain in the wound bed during definitive closure.…”

Management of Traumatic Bone Defects

“…Commercial antibiotic-PMMA mixtures that are available for primary total joint arthroplasty can be utilized (Biomet, Warsaw IN, Zimmer, Warsaw, IN, and Stryker, Mahwah, NJ). The surgeon, however, can prepare PMMA with higher amounts of added heat stable antibiotic to produce a bactericidal spacer [ 11 ].…”

Dead Space Management After Orthopaedic Trauma

“…The cement may alternatively be formed as beads (see Figures, Supplemental Digital Content 1, http:// links.lww.com/BOT/A538). 15,18,[24][25][26][27][28][29][30][31] Although this does not provide any skeletal stability, it can serve as an easily retrievable method for local antibiotic delivery and dead space obliteration. 14,16,17 There are several ways to increase the elution properties of the cement itself.…”

“…2A, B). [11][12][13][14][15][16][17][18][19][20][21][22][23] When mixed with antibiotic powder, it serves as a local antibiotic delivery vehicle capable of very high antibiotic concentrations when compared with levels obtained from systemic antibiotics. Block spacers offer enhanced skeletal stability and maintenance of soft tissue tension between debridements and/or while treating active infection.…”