Management of infected nonunions by using antibiotic-impregnated bone cement

Abstract

Background In patients with infected nonunion the primary goal is eradication of infection, before achieving union. Release of antibiotics from bone cement at a higher concentration prevents bacterial growth and formation of biofilm by bacteria. Penetration of antibiotics to the surrounding tissue, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. Patients and methods This was a prospective study of 12 patients with infected nonunions managed with antibiotic-impregnated bone cement who were followed up for an average period of 1.2 years, with encouraging results. The infected fracture site was exposed and thorough debridement done. The implant was replaced with vancomycin and clindamycin-impregnated cement following adequate debridement. Culture and sensitivity was done for the debrided tissues to identify the pathogen and sensitive antimicrobial agent. Follow-up was performed clinically, radiologically, and using laboratory investigations (by complete blood cell count, erythrocyte sedimentation rate, C-reactive protein). Results Infection was eradicated in all patients except one after an average period of 9 weeks (range: 6–14 weeks). Culture revealed no growth and discharge disappeared at the end of this period. Cement was removed after an interval of 6–12 weeks after control of infection and was replaced with definitive fixation with or without bone grafting. Conclusion Management of infected nonunions using antibiotic-impregnated cement is a simple and very effective method that allows infection control and promotes bone union. This simple procedure is encouraging, cost effective, and less cumbersome.