Abstract
Infected nonunion of long bones may require intravenous antibiotics over a lengthy period which may result in a high rate of complications. This study aims to assess the efficacy of local antibiotics used as a replacement to prolonged intravenous therapy. Thirteen patients with infected nonunion of long bones who failed at least one previous surgery were included. The infection was treated through extensive debridement, application of antibiotic-impregnated calcium sulphate pellets and the bone stabilized with external fixation. These patients were monitored for union and infection by clinical signs, laboratory values, and radiographs over a period of 24 months. The results support an eradication of infection and union in all patients with no antibiotic-associated complications. Local antibiotic delivery using calcium sulphate pellets provides an effective method for treatment of nonunion in long bones and is free of the complications from the intravenous route.
Highlights
Infected nonunion is a dreaded complication of the long bone fractures because its management is challenging to both the patient and the orthopaedic surgeon [1]
The aim of our study is to evaluate the resolution of infection and bone healing in patients with infected nonunion of long bones treated with extensive debridement, bone reconstruction and antibiotic-impregnated calcium sulphate pellets without subsequent use of systemic antibiotics
One patient had to undergo bone grafting for nonunion at the docking site, which subsequently healed
Summary
Infected nonunion is a dreaded complication of the long bone fractures because its management is challenging to both the patient and the orthopaedic surgeon [1]. Management involves surgical debridement, tissue reconstruction, a long-course of antibiotics and opioids. The complexity of care and its prolonged duration increases the cost of the treatment for the patient [2]. Adverse sequelae may lead to bone loss, residual deformity, or even amputation [1]. Recent advances in surgical technique have tilted the balance towards limb salvage surgery [1]; only a few high-quality studies exist which describe the most beneficial and cost-effective post-operative antimicrobial treatment approach [3]. The most widely used approach is extensive surgical debridement followed by 6 weeks of highdose intravenous (IV) antibiotics [4]
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