Abstract
Aim
The current treatment concepts of acute and chronic osteitis are associated with unsolved challenges and problems, underlining the need for ongoing medical research. The invention and prevalence of an absorbable, gentamicin-loaded ceramic bone graft, that is well injectable for orthopedic trauma and bone infections, enlarges the treatment scope regarding the rise of posttraumatic deep bone infections. This substance can be used either for infection, dead-space, or reconstruction management. The bone cement, eluting antibiotics continuously to the surrounding tissue, outperforms the intravenous antibiotic therapy and enhances the local concentration levels efficiently. This study aims to evaluate the power and practicability of bone cement in several locations of bone infections.
Method
The occurrence of posttraumatic infections with acute or chronic osteitis increases in trauma surgery along with progression of high impact injuries and consecutively high incidence of e.g. open fractures. We present a case-series of 10 patients with posttraumatic osteitis at different anatomic sites, who were treated in our level I trauma center. All of these patients received antibiotic eluting bone cement* for infection and reconstruction management.
Results
With admission to our trauma-center all patients with obvious or suspected osteitis undergo an inter-disciplinary pre-work up, including thorough clinical examination and different measures of diagnostic imaging, ultimately leading to the definition of an individual treatment plan. We diagnosed 10 bone infections anatomically allocated to the proximal (2x) and distal femur (3x), distal tibia (3x), tibial diaphysis (1x) and the ankle joint (1x). These ten patients were treated (1) with surgical debridement, (2) with an antibiotic eluting bone cement*, (3) bone stabilisation (including nail osteosynthesis, arthrodesis nails, plates, or external ring fixation), (4) optionally VAC-conditioning, and (5) optionally soft tissue closure with local or free flaps.
We observed very good clinical, functional and radiological results by using bone cement augmented with gentamicin. The overall treatment failure rate is low, throughout, all patients showed no signs of acute recurrence of infection. Pain and immobility decreased continuously with time. “White fluid” secretion was observed in one case.
Conclusion
Current concepts for treatment of osteitis include radical surgical debridement and additional antibiotic therapy. It could be demonstrated that the usage of an antibiotic biocement with osteoconductive characteristics enlarges the success rate in septic bone surgery. The treatment concepts, however, remain complex, time consuming, require a high patient compliance, and are highly individually.
*Cerement® G
