Antibiotic cement rod to control infection in infected humerus nonunion
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Published:
May 2, 2019
Keywords:
Nonunion, humerus fracture, antibiotic spacer, infection, endomedular rod, reconstruction
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Abstract
Objetive: To evaluate the efficiency of the antibiotic cement rod (ACR) in the eradication of infection in infected humerusnonunion (IHN).Material and methods: We included 11 patients with IHN with a mean age of 48 years. The time between fracture-surgery was 25 months. The ACR was impregnated with vancomycin in 9 of de 11 cases. Follow-up was 54 months.Results: Methicillinresistant staphylococcus aureus (MRSA) was isolated in 5 of cases. All patients received antibiotics systemically for 7 weeks. Vancomycin was the most commonly used antibiotic. Time between ACR and reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual space of the nonunion was measured with dichotomous variables and classified into two groups: group 1, < 2 cm (7 patients) and group 2, ≥2 cm (4 patients). No significant differences were observed between the number of days in which the ACR was placed and the development of the SAMR as compared to other germs [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p= 0.2002 Mann Whitney]. Nor were differences observed in the size of the defect in those who developed MRS or any other germ (p=0.242 Fisher). Reconstruction was performed with different techniques. Laboratory parameters were normal, cultures were negative. Fractures could be consolidated without infection recurrence.Conclusions: ACR is a good treatment option for a patient with an INH. The infection could be controlled in all of the cases, which allowed the secondary reconstruction of the nonunion
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Brandariz, R., Bennice, J., Boretto, J., Zaidenberg, E., De Carli, P., & Gallucci, G. (2019). Antibiotic cement rod to control infection in infected humerus nonunion. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(2), 90-98. https://doi.org/10.15417/issn.1852-7434.2019.84.2.849
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Clinical Research
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References
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6. Patzakis MJ, Wilkins J, Wiss DA. Infection following intramedullary nailing of long bones. Diagnosis and management. Clin Orthop Relat Res 1986;212:182-91. https://doi.org/10.1097/00003086-198611000-00020
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9. Koury KL, Hwang JS, Sirkin M. The antibiotic nail in the treatment of long bone infection: Technique and results. Orthop Clin N Am 2017;48(2):155-65. https://doi.org/10.1016/j.ocl.2016.12.006
10. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG Jr, Singh J. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma 2012;26(3):184-88. https://doi.org/10.1097/BOT.0b013e318225f77c
11. Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis PV. The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods. Bone Joint J Br 2014;96(6):783-88. https://doi.org/10.1302/0301-620X.96B6.32244
12. Bharti A, Saroj UK, Kumar V, Kumar S, Omar BJ. A simple method for fashioning an antibiotic impregnated cemented rod for intramedullaryplacement in infected non-union of long bones. J Clin Orthop Trauma 2016;7(2):171-6. https://doi.org/10.1016/j.jcot.2016.08.004
13. Ferreira N, Marais LC, Serfontein C. Two stage reconstruction of septic non-union of the humerus with the use of circular external fixation. Injury 2016;47(8):1713-8. https://doi.org/10.1016/j.injury.2016.06.014
14. Bassiony AA, Almoatasem AM, Abdelhady AM, Assal MK, Fayad TA. Infected non-union of the humerus after failure of surgical treatment: Management using the Orthofix external fixator. Ann Acad Med Singapore 2009;38(12):1090-4. http://www.annals.edu.sg/pdf/38VolNo12Dec2009/V38N12p1090.pdf
15. May JW, Jupiter JB, Weiland AJ, Byrd HS. Clinical classification of post-traumatic tibial osteomyelitis. J Bone Joint Surg Am 1989;71(9):1422-8. https://journals.lww.com/jbjsjournal/Citation/1989/71090/Clinical_classification_of_post_traumatic_tibial.27.aspx
16. Jain AK, Sinha S. Infected nonunion of the long bones. Clin Orthop Relat Res 2005;(431):57-65. https://doi.org/10.1097/01.blo.0000152868.29134.92
2. Lugones A, Paganini F, Fattor E, Allende B. Polimetilmetacrilato impregnado con antibiótico en el tratamiento de la seudoartrosis infectada y en defectos óseos segmentarios. Rev Asoc Argent Ortop Traumatol 2009;74(3):249-57. http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-74342009000300007&lng=es&nrm=iso>
3. Panteli M, Pountos I, Jones E, Giannoudis PV. Biological and molecular profile of fracture non-union tissue:
Current insights. J Cell Mol Med 2015;19(4):685-713. https://doi.org/10.1111/jcmm.12532
4. Conway J, Mansour J, Kotze K, Specht S, Shabtai L. Antibiotic cement-coated rods. Bone Joint J 2014;96(10):1349-54. https://doi.org/10.1302/0301-620X.96B10.33799
5. Shyam AK, Sancheti P, Patel S, Rocha S, Shyam A. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bone. Indian J Orthop 2009;43(4):396-402. https://doi.org/10.4103/0019-5413.55468
6. Patzakis MJ, Wilkins J, Wiss DA. Infection following intramedullary nailing of long bones. Diagnosis and management. Clin Orthop Relat Res 1986;212:182-91. https://doi.org/10.1097/00003086-198611000-00020
7. Cierny G, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 2003;414:7-24. https://doi.org/10.1097/01.blo.0000088564.81746.62
8. Gallucci G, Donndorff A, Boretto J, Constantini J, De Carli P. Infected nonunion of the humerus treated with an antibiotic cement rod. Case report. Chir Main 2007;26(4-5):248-51. https://doi.org/10.1016/j.main.2007.07.006
9. Koury KL, Hwang JS, Sirkin M. The antibiotic nail in the treatment of long bone infection: Technique and results. Orthop Clin N Am 2017;48(2):155-65. https://doi.org/10.1016/j.ocl.2016.12.006
10. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG Jr, Singh J. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma 2012;26(3):184-88. https://doi.org/10.1097/BOT.0b013e318225f77c
11. Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis PV. The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods. Bone Joint J Br 2014;96(6):783-88. https://doi.org/10.1302/0301-620X.96B6.32244
12. Bharti A, Saroj UK, Kumar V, Kumar S, Omar BJ. A simple method for fashioning an antibiotic impregnated cemented rod for intramedullaryplacement in infected non-union of long bones. J Clin Orthop Trauma 2016;7(2):171-6. https://doi.org/10.1016/j.jcot.2016.08.004
13. Ferreira N, Marais LC, Serfontein C. Two stage reconstruction of septic non-union of the humerus with the use of circular external fixation. Injury 2016;47(8):1713-8. https://doi.org/10.1016/j.injury.2016.06.014
14. Bassiony AA, Almoatasem AM, Abdelhady AM, Assal MK, Fayad TA. Infected non-union of the humerus after failure of surgical treatment: Management using the Orthofix external fixator. Ann Acad Med Singapore 2009;38(12):1090-4. http://www.annals.edu.sg/pdf/38VolNo12Dec2009/V38N12p1090.pdf
15. May JW, Jupiter JB, Weiland AJ, Byrd HS. Clinical classification of post-traumatic tibial osteomyelitis. J Bone Joint Surg Am 1989;71(9):1422-8. https://journals.lww.com/jbjsjournal/Citation/1989/71090/Clinical_classification_of_post_traumatic_tibial.27.aspx
16. Jain AK, Sinha S. Infected nonunion of the long bones. Clin Orthop Relat Res 2005;(431):57-65. https://doi.org/10.1097/01.blo.0000152868.29134.92