The control of dead space with antibiotic loaded cement beads and nails in high energy trauma

Abstract

Purpose:To treat delayed present (more than 24h) and Gustilo type III fractures in a better way than external fixation which before was a routine in our hospital. Methods: We have applied advanced trauma life support control (ATLS). After proper debridement of the wound, irrigation with saline and antibiotic cover, we reduced the fracture with the Sign IM nail, which is a solid nail without internal dead space, and then we added antibiotic loaded cement with 3g of Amikacin and 4g of Vancomycin. Results: Out of 38 delayed present fractures, we have observed serous discharge in 3 cases which have been controlled by changing the antibiotic loaded cement. While the other cases remained uninfected. Conclusion:The best way to deal with infection is to prevent it, while other factors as obesity, diabetes, and other co-morbidities increase the risk of infection. In our method, we also provided local high concentration of antibiotic with the use of cement loaded antibiotic, and the control of dead space with bone defect and tissue loss. If we do not put cement or other solid material, then blood will definitely take space and that would be a media for infection.