The levels of vancomycin in the blood and the wound after the local treatment of bone and soft-tissue infection with antibiotic-loaded calcium sulphate as carrier material

Meng

et al. 2020

Preprint

Background: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

Section: Discussionmentioning

confidence: 97%

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Zhang

Meng

et al. 2020

Preprint

“…The main difference is the replacement of temporary antibiotic-impregnated PMMA beads or autologous tissues grafts by biodegradable antibiotic-impregnated calcium sulfate, which undoubtedly has its unique advantages. Primarily, the predictable high local antibiotic concentration (hundreds to thousands times higher than MIC in first 24h to 48h) and comparatively long therapeutic duration (several weeks to months) [5,17,18] provided by the degrading antibiotic-loaded calcium sulfate undoubtedly eliminates more residual pathogens while significantly shortens the conventional duration of systemic antibiotics administration. Moreover, similar to PMMA, the well-reported osteo-conductivity of calcium sulfate provides a crystalline structure for the osteoblasts perivascular mesenchymal tissues and osteoprogenitors, along which osteoblasts and the others crawl easily and eventually achieve the self-repair without autogenous bone grafts [19,20].…”

Section: Discussionmentioning

confidence: 99%

Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation：a retrospective study of 42 patients.

Ren

Adem

et al. 2020

Preprint

Background: Although various methods have been introduced, the management of chronic tibial osteomyelitis remains a challenge. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis.Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received the treatment method mentioned above were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed. Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed minor but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-ray’s examination, bone losses caused by local debridement were generally repaired, though the shape of the tibia was not well restored to its initial form in 17 limbs. No fracture was recorded during follow-up. Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.

“…The main difference lies in the replacement of temporary antibiotic-impregnated PMMA beads or autologous tissues grafts with biodegradable antibiotic-impregnated calcium sulfate, which undoubtedly owns its unique advantages. Primarily, the predictable high local antibiotic concentration (hundreds to thousands times higher than MIC in first 24h to 48h) and comparatively long therapeutic duration (several weeks to months) [5,17,18] produced by the degrading antibioticloaded calcium sulfate undoubtedly eliminates more residual pathogens while significantly shortens the conventional duration of systemic antibiotics administration. Moreover, similar to PMMA, the wellreported osteo-conductivity of calcium sulfate provides a crystalline structure for the osteoblasts perivascular mesenchymal tissues and osteoprogenitor, along which osteoblasts and the others crawl easily and eventually achieve the self-repair without autogenous bone grafts [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Since the extent of infection is comparatively limited, the clinical symptoms and presentations might not be as severe as the diffused osteomyelitis, which means a better outcomes could be achieved if treated immediately and appropriately. In the aspect of surgical management, local debridement without segmental bone resection as the standard surgical management allows the restoration of enough healthy bones, which avoids the massive bone loss and tedious secondary reconstruction to restore the length of tibia [5,6].…”

Section: Introductionmentioning

confidence: 99%

Single-stage treatment of chronic localized tibial osteomyelitis with local debridement and antibiotic-loaded calcium sulfate implantation:a retrospective study of 42 patients.

Ren

Adem

et al. 2020

Preprint

Background: The management of chronic tibial osteomyelitis is still a challenge, even with various methods have been introduced. This study aims to assess a combined treatment method, local debridement combined with antibiotic-loaded calcium sulfate implantation, for the management of the local (Cierny-Mader type III) tibial osteomyelitis. Methods: 42 patients (43 limbs) with type III tibial osteomyelitis, from January 2012 to December 2018, who received above mentioned treatment method were included in the study. The infection remission rate, recurrence rate, complication rate and bone healing rate were respectively analyzed. Results: With a mean follow-up of 42.8 months, 38 limbs (37 patients) (88.4%, 38/43) achieved infection remission without recurrence. Among those patients, pain, limitation of movement, sinus tracts, topical redness and swelling were generally eliminated. Only 4 patients felt slight pain after a long-distance walk, while another 6 patients showed slight but acceptable discomfort in affected limbs. 5 patients (11.6%) suffered from osteomyelitis recurrence that required secondary surgical and medical treatment, but no amputation was necessary to eliminate the infection. Prolonged aseptic drainage was the most frequent complication that was observed in 13 patients (30.0%). They were successfully managed by appropriate wound caring in 10 patients and by surgical intervention, months later, in 3 patients. According to the final X-rays examination, bone losses caused by local debridement were generally repaired, though the shape of tibia was not well restored to its initial form in 17 limbs. No fracture was recorded during follow-up. Conclusion: Local debridement combined with antibiotic-loaded calcium sulfate implantation is effective and safe in a single-stage treatment of chronic Cierny-Mader III tibial osteomyelitis.