Abstract
Objective:To explore the clinical effects upon gap nonunion of antibiotic-loaded bone cement spacer combined with membrane induction on infected bone defects.Methods:The data of 16 patients with infected bone defects admitted in General Hospital of Shenyang Military Area Command from January 2009 to January 2011 were analyzed retrospectively. There were 12 males and 4 females aged between 24-63 years age (average 43.1 ± 9.7) who had received antibiotic laiden bone cement spacer treatment. Stage-1, debridement and anti-biotic treatment with intraoperative preparation of customized bone cement spacers (antibiotics and bone cement spacer) with or without internal or external fixation Stage-2, removal of spacer and repair of bone defects using membrane-induced technique and internal fixation at bone defects site.Results:Sixteen patients were followed up for 39-98 months, (67.2 ± 20.4) on average. All patients with infected bone defects were healed. X-ray showed that fractures had healed and the new bone formed at graft site was more radio opaque than that of adjacent bone segments. The healing time was 6 to 10 months, (7.4 ± 1.1) on average. There was no recurrence of infection or deformity.Conclusion:The antibiotic-loaded cement spacer can control the local infection while maintaining the limb length and increasing the stability, reducing the contracture of bone and soft tissue, creating conditions for subsequent repair and reducing the infection rate of bone defects.
Highlights
Infectious bone defects are commonly disabling diseases and are mainly caused by high-energy trauma such as traffic injuries and firearm injuries
In the process of surgical exploration and debridement, necrotic tissues on the wound surface were completely removed, including sequestrum and cicatricial tissue with poor blood supply; the original internal fixation device was removed and replaced with external fixation or gypsum back slab; reduction was performed at the bone defect site as best as possible, with internal fixation and realignment of fracture The antibioticloaded bone cement spacer was planted at the gap and if the wound was large or had poor soft tissue coverage, vacuum sealing drainage was used to assist the attachment with negative pressure
Stage-2: After infection was under control, antibioticleaded bone cement spacer and chain beads were surgically removed for membrane induction
Summary
Infectious bone defects are commonly disabling diseases and are mainly caused by high-energy trauma such as traffic injuries and firearm injuries. The open surgery for both open fractures of the limbs and fractures can lead to bacterial infections. Dead bone pieces can encourage mass reproduction of bacteria lead to bone sepsis, resulting in nonunion or delayed healing. The features include high infection rate, severely reducing adjacent joint function repeated treatment cycle and high morbidity. It has always been a major challenge to treat bone defects in the field of traumatic orthopedics.[1,2,3] Acute trauma frequently devitalizes so much soft tissue and the injured bone fragments favoring bacterial
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