An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Abstract

Background: The induced membrane technique has achieved good clinical results in the treatment of infected bone defects, and external fixation is the main method, but it causes inconvenience and complications in patients. In this study, our objective was to investigate the outcomes of using an antibiotic cement-coated locking plate as a temporary internal fixation in the first stage of the surgical induced membrane technique for treating extremities with infected bone defects. Methods: We retrospectively analysed patients with lower extremity infected bone defects in our department between January 2013 and December 2017. All patients were treated with the induced membrane technique. In the first stage, the defects were stabilized with an antibiotic cement-coated locking plate as a temporary fixation after debridement, and polymethyl methacrylate cement was implanted to induce the formation of a membrane. In the second stage, bone grafting rebuilt the bone defects after infection control, and the temporary fixation was changed to a stronger fixation. Results: A total of 183 patients were enrolled, with an average follow-up duration of 32.0 (12-66) months. There were 154 males and 29 females with an average age of 42.8 (10-68) years. The infection sites included 81 femurs, 100 tibias and 2 fibulas. After the first stage of treatment (infection control), 16 (8.7%) patients had recurrence of infection. In terms of the incidence of complications, 4 patients had poor wound healing, 2 patients had fixation failure and 1 patient had femoral fracture due to a fall. After the second stage of treatment (bone reconstruction), there were 24 (13.1%) recurrences of infection, with a mean time of 9.9 months (range 0.5 to 36). Among them, 18 patients underwent bone grafting after re-debridement, 6 received permanent placement of antibiotic bone cement after debridement and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175 (95.9%) patients at the last follow-up, and the average time to bone union was 5.4 (4-12) months. Conclusions: Antibiotic cement-coated locking plates have good clinical effects in the control of bone infection, but attention must be paid to the possible difficulty of skin coverage when applied in calves.

Two-stage surgery for adult patients with chronic hematogenous osteomyelitis of the femur or tibia: A case series study

“…Other studies con rmed that antibiotic bone cement does not affect the osteogenic effect of the induced membrane [17,25,26]. In the present study, the post-stage I X-ray revealed that the bone ends were xed by LCP, and the defected area was lled with antibiotic-loaded bone cement; the infection was controlled in the stage surgery.…”

“…The induced membrane technique is a two-stage procedure: the rst stage includes debridement, positioning of a cement spacer into the bone defect, bone stabilization, and soft tissue reconstruction; the second stage includes sharp dissection of the membrane, cement removal, and autologous grafting of the defect [11,21]. The induced membrane technique is widely used in the treatment of chronic bone infections of extremities and has achieved good results [11,25,26]. Wang et al [5] used the induced membrane technique to treat 15 patients with chronic hematogenous osteomyelitis of the tibia.…”

O uso de placas revestidas de cimentado com antibiótico é uma técnica viável e eficiente para o tratamento da pseudoartrose infectada da metáfise do fêmur e da tíbia

“…Nossos achados estão em concordância ao que vem sendo relatado sobre o uso de placas revestidas de cimento antibiótico no tratamento de pseudoartrose infectada de fêmur e tíbia. Liporace et al 23 A reconstrução do envelope de tecido mole é um componente importante do tratamento das pseudoartrose infectadas dos ossos longos 1,7,15,31 .…”

Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures

“… 30 Incomplete debridement is the major reason of recurrent infection. 20 , 30 , 31 Masquelet et al 32 reported that inadequate debridement could be avoided through repeated debridement sessions and the usage of a spacer without antibiotics. Simpson et al 24 suggested that all necrotic and infected bone should be excised with 5 mm or more healthy tissue margin in Cierny-Mader Host B, and less than 5 mm healthy tissue margin in Cierny-Mader Host A.…”

“…37 Compared with an external fixator, this fixation provides greater stability and comfort level without increasing the recurrence rate of infection. 31 One limitation of this technique is the fact that the coating does not protect screws and fixation holes. 38 Additionally, coating efficacy may be hindered by gentamicin/vancomycin resistance.…”