The use of adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo Anderson type IIIB fractures. A prospective review

Jahangir, Noman; Niazi, Noman; Aljawadi, Ahmed; Reid, Adam J.; Wong, Jason; Drampalos, Efstathios; Pillai, Anand

doi:10.1016/j.jor.2019.03.013

Cited by 10 publications

(8 citation statements)

References 53 publications

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“…The compressive strength provided by this injectable bio-ceramic is like that of cancellous bone [1]. Cerament G has been used successfully used in our department as void filler for treatment of chronic osteomyelitis and open Gustilo Anderson type IIIB fractures [2].…”

Section: Case Reportmentioning

confidence: 99%

Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

Aljawadi¹,

Al-salihy²,

Pillai³

et al. 2019

SCR

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Introduction: Large traumatic bone voids are challenging to treat. Autografts are associated with donor site morbidity and limited availability. Bone graft substitutes are successful alternative to fill bone voids. Case Presentation: The management of two patients with an open tibial fracture with segmental bone loss and other patient with periarticular calcaneal void associated with chondral loss. Treatment and outcomes: For first case, a contained cavity was made using Septocoll E, an absorbable collagen fleece, to mimic a pseudo-membrane using Masquelet-technique. Bone void was filled with Cerament-G and autologous bone graft. Second case with large peri-articular calcaneal void and chondral loss, Cerament-G and autologous bone graft were used, and articular defect reconstruction was done with synthetic chondral tissue. Both patients had painless mobility and consolidation of bone void. Discussion: We represent two exceptional cases of traumatic bone void which were treated with modified masquelet/modified AMIC with Cerament Bio-Composite with satisfactory outcomes

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Section: Case Reportmentioning

confidence: 99%

Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

Aljawadi¹,

Al-salihy²,

Pillai³

et al. 2019

SCR

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“…Clinical trials demonstrated that Cerament is a viable replacement to bone grafting in filling voids and gaps following fractures [11]. However, in recent literature there is clear evidence of lower infection rates in after additional local antibiotics at least in grade III open fractures [12]. Early histology of Cerament G in Ferguson et al [3] shows nicely the CERAMENT G covered by an osteoid-like matrix produced by osteoblastic cells seen lining the bone graft substitute's surface.…”

Section: Orthopedics and Rheumatology Open Access Journal (Oroaj)mentioning

confidence: 99%

Individualized techniques of Implant Coating with an Antibiotic-loaded, Hydroxyapatite/Calcium sulphate Bone Graft Substitute

Aparicio¹

2019

OROAJ

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Background:The treatment of fracture-or non-union-related infections has persistently been a major challenge for both patients and treating surgeons. With rising aging of patients and increasing comorbidities, combined with the heterogeneity of germs and any number of multi-resistance against standard antibiotics, a successful treatment is increasingly difficult. One potential solution could be a custom-made individualized antibacterial coating of standard implants with a biphasic degradable biocarrier that releases high doses of antibiotics around the bone-implant-interface. Here we describe our technique of coating intramedullary nails, plates and press-fit shoulder endoprostheses which may prevent bacterial adhesion and biofilm formation. So far, there is very limited experience in individual coating of implants in hip or knee endoprostheses to prevent reoccurrence of surgical-site infection. Currently no reports are available for coating of stems of shoulder prosthesis and nails or plates for fracture fixation.Methods: Here we show our first experiences with a new individualized surgical technique of coating these implants with a resorbable antibiotic-loaded hydroxyapatite / calcium sulphate biocomposite to prevent biofilm formation and thereby recurrence of bone or joint infection. We describe three cases for coating of plates and nails for fracture fixation and coating of stems of a shoulder prosthesis.Results: No adverse events of the resorbable bone graft substitute were observed. In all the cases no recurrence of the infection was observed, and osseo-integration was achieved. After implant coating of the shoulder prosthesis no radiological signs of loosening were detected. Conclusion:We present a new surgical approach of a surface coating of plates, intramedullary nails or prostheses. The osteoconductive-and anti-inflammatory effect of the gentamicin-or vancomycin-loaded hydroxyapatite / calcium sulphate bone graft substitutes shows promising results.

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“…Hydroxyapatite provides a scaffold-like structure as the Calcium Sulphate resorbs, hence it improves bone healing at the fracture site. As well as Cerament-G elutes antibiotics locally which helps to reduce the deep infection rate [ 8 , 9 ]. Cerament-G has been reported to show good radiological signs of successful remodelling and to promote bone healing when used for patients with bone tumours and patients with osteomyelitis [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in the Management of Patients With Traumatic Bone Voids

Aljawadi¹,

Naylor²,

Islam³

et al. 2022

Cureus

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BackgroundManagement of traumatic bone voids has always been challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) showed encouraging results in achieving good bone healing with a satisfactory degree of resorption when utilised as a void filler. This study aims to assess the radiological signs of Cerament-G remodelling when used for patients with traumatic bone voids. MethodsRetrospective data analysis of all patients admitted to our unit between 2015 and 2021 with traumatic bone voids who had Cerament-G applied intraoperatively as a void filler. Postoperative radiographic images of the fracture site at six weeks, three months, six months, and at the final follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing at the final follow-up were assessed. ResultsA total of 51 patients (52 fractures) were included in the study. Among them 10 were female and 41 were male with a mean age of 42.7 (11 -90) years. The mean void size was 6.58 cm 3 . Mean follow-up duration was 9.73 months. Primary fracture union was achieved in 44 (86.3%) patients. Delayed union was reported in six (11.7%) patients, while one (1.9%) patient had non-union. Twenty-seven (52%) patients had >90% of void healing with normal trabecular bone. Twenty (38.5%) patients had 50-90% void healing with normal bone. Whereas only five (9.5%) patients had less than 50% of void healing. ConclusionCerament-G used as a void filler for patients with traumatic bone void has resulted 98% fracture union rate with good signs of radiological remodelling into a trabecular bone. More than 50% void filling with new trabecular bone was reported in more than 90% of patients. Non-union was reported in only one patient.

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The use of adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo Anderson type IIIB fractures. A prospective review

Cited by 10 publications

References 53 publications

Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

Individualized techniques of Implant Coating with an Antibiotic-loaded, Hydroxyapatite/Calcium sulphate Bone Graft Substitute

Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in the Management of Patients With Traumatic Bone Voids

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