The Use of Calcium Sulfate Impregnated With Vancomycin in the Treatment of Open Fractures of Long Bones: A Preliminary Study

Abstract

The purpose of this study was to investigate the effect of calcium sulfate impregnated with vancomycin combined with internal fixation in the treatment of open fractures of long bones. Between October 2007 and January 2008, twenty-eight patients (24 men, 4 women) who sustained open fractures of long bones were enrolled. Mean patient age was 34.5 years (range, 19-57 years). According to the classification system developed by Gustilo and Anderson, there were 15 type II open fractures, 11 type IIIa open fractures, and 2 type IIIc open fractures. All the patients were treated with vancomycin-loaded calcium sulphate and internal fixation. Clinical signs of wound infection were recorded. Postoperative radiographs were used to evaluate the bone healing and absorption process.Twenty-six of 28 patients were followed-up successfully, with an average follow-up of 10.5 months (range, 6-16 months). No infection was present in the 26 patients. Exudation from the incision or the drain incision was observed in 2 patients. Bacteria culture was negative and the wound healed with dressing change within 15 days. Bone union was observed in 23 patients, with a mean bone union time of 5.8 months (range, 4-9 months). All the calcium sulfate pellets had completely resorbed in an average of 1.4 months (range, 1-2 months). Our study showed that the combination of internal fixation and calcium sulfate impregnated with vancomycin could decrease the incidence of deep infection without impairment to the bone healing process in the treatment of open fractures of long bones.

Elution Profiles of Synthetic CaSO4 Hemihydrate Beads Loaded with Vancomycin and Tobramycin

“…These advantages make the use of a calcium sulfate vehicle intriguing for application in several scenarios, including abscess or soft tissue infection treatment, prophylaxis in high-risk patients, use with physiologic constructs in onestage procedures for osteomyelitis, and as an adjunct to antibiotic-loaded bone cement. Preparation of calcium sulfate beads provides a stable platform for the delivery antibiotics; however, problems associated with the use of calcium sulfate involve complications with persistent postoperative wound drainage [35][36][37][38][39][40]. We feel this drainage may be due to specific physical properties of gypsum-mined calcium sulfate preparations, including its hydrophobicity, acidic pH, and impurity due to the presence of trace minerals as seen by Fourier transform infrared (FTIR) analysis.…”

Perspectives on the prevention and treatment of infection for orthopedic tissue engineering applications

“…Studies on the efficacy of calcium sulfate as a drug-delivery vehicle are widely varied. A 2010 study shows that calcium sulfate pellets are highly efficacious, with resolution of osteomyelitis in all patients followed [25]. However, a 2009 retrospective study on the use of antibiotic-loaded calcium sulfate in combat-related open fractures was less positive, with a 22% rate of osteomyelitis, a 25% rate of heterotopic ossification in patients whose limbs were not eventually amputated, and over half of patients experiencing sterile draining sinuses [26].…”

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

“…This protocol was then used to determine the elution profiles of four commonly used antibiotics, namely tobramycin, gentamicin, vancomycin, and rifampicin over a period of 42 d, the typical time period over which calcium sulfate beads would be resorbed fully in vivo [45,46].…”