Outcome in Patients With an Infected Nonunion of the Long Bones Treated With a Reinforced Antibiotic Bone Cement Rod

Selhi, Harpal Singh; Mahindra, Pankaj; Yamin, Mohammad; Jain, Deepak; Long, William G.; Singh, Jaspreet

doi:10.1097/bot.0b013e318225f77c

Cited by 63 publications

(47 citation statements)

References 14 publications

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“…Recurrence of infections occurred in two patients in our study. It was also reported by a few other researchers like Qiang et al 12 , Selhi et al 31 . Timely removal of nail is recommended once the infection has subsided because theoretically live bacteria are known to persist on antibiotic impregnated cement under in vitro conditions 32 .…”

Section: Discussionsupporting

confidence: 74%

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Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

Bhatia

Sharma

et al. 2017

MOJ

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IntroductionInfected nonunion of long bones is a chronic and debilitating disorder. It is more difficult to deal with when the implant used for internal fixation itself becomes a potential media for infection because of bacterial adhesion and biofilm formation. Traditionally, it is managed by two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement coated nailing as single stage treatment modality for treating infection and achieving stability at the same time.Materials and MethodsTwenty patients (above 18 years of age) with infected nonunion of tibia with bone gap less than 2 cm were managed using antibiotic cement coated K-nail. Antibiotic cement nail was prepared using endotracheal tube method. Antibiotics used were a combination of vancomycin and teicoplanin.ResultsInfection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Remaining 8 patients required additional procedures like bone grafting or exchange nailing and these were done in six patients, with union of fracture. Two patients refused to undergo further procedures. Complications encountered were difficult nail removal in three cases, broken nail in two cases, and bent nail in one case. Recurrence of infection was observed in two patients. Average period of follow-up was 13 months.ConclusionAntibiotic cement impregnated nailing is a simple, economical and effective single stage procedure for the management of infected nonunion of tibia. It is advantageous over external fixators, as it eliminates the complications of external fixators and has good patient compliance. The method utilizes existing easily available instrumentation and materials and is technically less demanding, and therefore can be performed at any general orthopaedic center.

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Section: Discussionsupporting

confidence: 74%

“…Most of the researchers in past used a combination of vancomycin with gentamicin or tobramycin 11,14,19,30,31 . In our study, we used a combination of vancomycin and teicoplanin as most of the culture and sensitivity reports from the patients at our center were reporting staphylococcus aureus which was resistant to gentamicin.…”

Section: Discussionmentioning

confidence: 99%

Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

Bhatia

Sharma

et al. 2017

MOJ

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“…Either as an element of the induced membrane staged protocol [55], when polymethylmethacrylate (PMMA) cement is mixed with gentamycin, vancomycin, even with antifungal agents, and left for 2-3 months before the next stage [7], or when absorbable carriers e.g. calcium sulphate with antibiotics [56,57], or even the mixture of antibiotics to morselised cancellous bone [49,52], or in the form of intramedullary PMMA rods [58,59], they are considered as a safe and effective adjunct.…”

Section: Factors Implicationsmentioning

confidence: 99%

Surgical management of infected non-unions: An update

Kanakaris

Tosounidis

Giannoudis

2015

Injury

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“…If most of the patients have healing, many require repeat surgery using several bone grafting because no satisfactory progress of fracture healing is usually observed during the first months, sometimes due to graft resorption in relation with uncontrolled infection at the site of the fracture despite systemic antibiotics. When healing is obtained, complications are observed and frequently related to the numerous iliac crest donor sites and persistent infection at the nonunion site [15][16][17][18][19][20][21][22] (Figs. 1 and 2).…”

mentioning

confidence: 99%