Antibiotic cement-coated rods

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Abstract

The treatment of infected nonunions is difficult. Antibiotic cement-coated (ACC) rods provide stability as well as delivering antibiotics. We conducted a review of 110 infected nonunions treated with ACC rods. Patients were divided into two groups: group A (67 patients) with an infected arthrodesis, and group B (43 patients) with an infected nonunion in a long bone. In group A, infected arthrodesis, the success rate after the first procedure was 38/67 (57%), 29/67 (43%) required further surgery for either control of infection or non-union. At last follow-up, five patients required amputation, representing a limb salvage rate of 62/67 (93%) overall. In all, 29/67 (43%) presented with a bone defect with a mean size of 6.78 cm (2 to 25). Of those with a bone defect, 13/29 (45%) required further surgery and had a mean size of defect of 7.2 cm (3.5 to 25). The cultures were negative in 17/67 (26%) and the most common organism cultured was methicillin-resistant staphylococcus aureus (MRSA) (23/67, (35%)). In group B, long bones nonunion, the success rate after the first procedure was 26/43 (60%), 17/43 (40%) required further surgery for either control of infection or nonunion. The limb salvage rate at last follow-up was 43/43 (100%). A total of 22/43 (51%) had bone defect with a mean size of 4.7 cm (1.5 to 11.5). Of those patients with a bone defect, 93% required further surgery with a mean size of defect of 5.4 cm (3 to 8.5). The cultures were negative in 10/43 (24%) and the most common organism cultured was MRSA, 15/43 (35%). ACC rods are an effective form of treatment for an infected nonunion, with an acceptable rate of complications.

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Most cited references 17

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A clinical staging system for adult osteomyelitis.

Jon Mader, G Cierny, Johan Penninck (2003)

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Local antibiotic delivery vehicles in the treatment of musculoskeletal infection.

Arlen D. Hanssen (2005)

The primary benefit achieved with local antibiotic delivery vehicles is the ability to obtain extremely high levels of local antibiotics without increasing systemic toxicity. Antibiotic-loaded bone cement represents the current standard as an antibiotic delivery vehicle in orthopaedic surgery. Biodegradable alternatives to antibiotic-loaded bone cement also are being used clinically and there are many new products in the active stages of development. These alternatives can be categorized as bone graft, bone graft substitutes or extenders, natural polymers (protein-based products), and synthetic polymers. Composite biomaterials that simultaneously provide the functions of variable antibiotic delivery patterns and also contribute to the process of bone regeneration represent the most ideal class of local antibiotic delivery vehicles. High concentrations of certain antibiotics have been shown to affect the process of normal bone regeneration adversely in a dose dependent response. Considerable investigation still is required to determine the proper use of locally administered antibiotics to negotiate the balance between eradicating infection without excessively inhibiting the processes of bone regeneration.

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Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects.

Raghuram Thonse, J. Conway (2007)

Chronic infection of bone with nonunion and/or bone defects is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which antibiotic cement-coated interlocking intramedullary nails are prepared in the operating room with the use of nails and materials that generally are available is herein described. Although useful for all infected nonunions and/or segmental bone defects, this technique is particularly useful for patients who are not ideal candidates for external fixation and for those who do not want to have an external fixator applied. This technique was used in a series of 20 patients. In 17 patients, the goal of bony union was achieved (85%). In the remaining 3 patients (15%), the goal of control of infection was achieved with stable nonunion (1 patient) and stable nonunion with cement spacer (2 patients). In 95% of the patients (19 of 20 patients) control of infection was achieved except for in 1 patient, who had a bony union with intermittent wound discharge and subsequently underwent an above-the-knee amputation. Three patients (15%) needed exchange nailing to another antibiotic cement-coated nail (for continued infection) before complete control of infection could be achieved. Four patients (20%) experienced cement-nail debonding during removal of the antibiotic cement-coated nail (3 during exchange to an uncoated intramedullary nail, 1 during removal at the request of patient). One patient experienced partial debonding at insertion, coinciding with the site of segmental defect, which was treated with an antibiotic cement spacer. In summary, control of infection and stability to promote union has traditionally been provided by 2 separate procedures, which have proved to be efficacious in the past. However, both these goals can be achieved in half the patients with 1 surgical procedure in a variety of scenarios using the technique of an antibiotic cement-coated intramedullary nail.