Antibiotic laden bone cement in chronic osteomyelitis

Abstract

Background: Chronic osteomyelitis is a dreaded sequel to acute haematogenous osteomyelitis. It is also more frequent following open fracture and orthopedic surgeries. Principle in treatment of chronic osteomyelitis based on removal of devitalized tissue and filling up of dead space. Systemic antibiotic therapy may not provide minimum inhibitory concentration for prolong period. Antibiotic laden bone cement can be used in adjunct to usual treatment of debridement and systemic antibiotic therapy for local antibiotic delivery and filling dead space temporarily. Material and Method: 32 cases of chronic osteomyelitis (7 haematogenous and 25 exogenous following trauma or surgery) were included in our study which included 21 male and 9 female, age ranging from 18 to 55 year. Pre-operative culture from sinus tract, ESR, and CRP were done. All patient were treated with debridement and removal of implant if present, followed by filling the dead space by antibiotic laden bone cement beads or antibiotic laden bone cement coated nail. Control of infection was assessed by laboratory parameter. Antibiotic cement was removed at an average of 10.62 weeks. All patients were followed up for at least 2 years. Result: Infection was controlled in 28 patients out of 32 patients at the time of cement removal, secondary procedure was done in all patients of infected non union in the form of bone grafting and definite fixation except 3 patients where antibiotic cement coated nails are retained till union as there was callus formation at the end of three month. Conclusion: Antibiotic laden cement is an effective method in local control of infection in chronic osteomyelitis without any systemic side effect.