The Use of Antibiotic-Loaded Absorbable Calcium Sulfate Beads in Open Fractures

Abstract

Aim: The aim of our study was to evaluate the complication rates associated with open long bone fractures and to assess the bony union when antibiotic-loaded calcium sulfate beads were used with definitive fixation. Materials and Methods: A single-centered prospective study on 56 consecutive series of patients who had open fractures of long bones of different grades presented to our emergency department between April 2018 and March 2022. There were 68 long bone open fractures for these 56 patients. After evaluating the patient with advanced trauma life support protocol, the patient underwent wound debridement and primary definitive fixation. The unstable patients were managed with damage control procedures. We used absorbable vancomycin-loaded synthetic calcium sulfate beads in all cases while performing the definitive fixation. The follow-up was done at 2 weeks, 6 weeks, 12 weeks, 6 months and 12 months, and 6 months thereafter. We recorded complications such as infection, nonunion, delayed union, malunion, and implant loosening till the latest follow-up. Results: Fifty-six patients with long bone open fractures (39 males and 17 females) having a mean age of 44 years (range 17–68 years) were operated. There were 68 long bone open fractures for these 56 patients. We operated on 24 tibia, 17 femur, 10 ankle, 10 forearm, and 7 humerus open fractures. According to Gustilo-Anderson classification, there were 16 Type I, 12 Type II, and 40 Type III (Type IIIa-29, Type IIIb-6, and Type IIIc-5) fractures. We performed wound debridement and primary definitive fixation in 52 patients and delayed the definitive fixation in those who had other severe injuries to manage (16 cases). The mean follow-up period was 22 months (range: 14–42 months). The mean time for union was 2.4 months (range: 2–3.6 months). There were no cases of infection, nonunion, or delayed union in our study. Conclusion: Our research has demonstrated that meticulous debridement and early internal fixation of long bone open fractures in conjunction with antibiotic-impregnated calcium sulfate can lessen the risk of deep infection and enhance bone healing.