Abstract
Introduction
Infection following traumatic injury of the tibia is challenging, with surgical debridement and prolonged systemic antibiotic therapy well established. Local delivery via cement beads has shown improved outcome, but these often require further surgery to remove. Osteoset-T is a bone-graft substitute composed of calcium sulphate and 4%-Tobramycin, available in pellets that are packed easily into bone defects. Concerns remain regarding the sterile effluent produced as it resorbs, along with the risk of acute kidney injury following systemic absorption.
Purpose
We present outcomes of 22 patients treated with Osteoset-T.
Methods
Medical notes were reviewed of every case of osteomyelitis of the tibia over a 30-month period, in which Osteoset-T had been used. Excision of infected soft tissue and tibial debridement was performed. Metalwork whenever present removed, before Osteoset-T pellets were packed into any cortical defects or the intra-medullary canal. Further stabilisation (n=9) and soft tissue reconstruction (n=7) was undertaken as required. Intravenous vancomycin and meropenem was administered after sampling. Meropenem discontinued after 3 days if no gram negatives cultured, and vancomycin continued for 1 week. Thereafter targeted antibiotic therapy given for 6 weeks, or ciprofloxacin and rifampicin orally if no growth.
Results
Average follow-up was 16 months, with wound complications encountered in 50%. A wound discharge in the early post-operative period was noted in 8 patients (36%) independent of site of Osteoset-T placement, with 6 demonstrating wound healing complications. Whereas only 5 of 14 patients without wound leak developed wound complications, but the difference did not reach significance (p=0.18, Fisher exact test). Union rate and infection eradication was 100%, with only one patient developing a transient acute kidney injury.
Conclusion
Despite a high incidence of wound discharge that may promote healing complications, Osteoset-T is an effective adjunct in treatment of chronic tibial osteomyelitis following trauma, with nephrotoxicity concerns not warranted.
