Treatment of osteomyelitis following surgery of open tibial fracture with vancomycin calcium sulphate or vancomycin cement

Abstract

Objective To evaluate curative efficacy of vancomycin calcium sulphate or vancomycin cement applied topically to treat osteomyelitis after surgery of open tibial fracture.Methods From May 2005 to August 2013,418 patients with osteomyelitis following surgery of open tibial fracture were treated in our center.They were 257 males and 161 females,with an average age of 35.6 years (from 19 to 55 years).There were 163 cases of Gustilo type Ⅰ,132 cases of Gustilo type Ⅱ,56 cases of Gustilo type ⅢA,and 67 cases of Gustilo type Ⅲ B.The initial fractures were fixated at other hospitals with plate in 334 cases,with intramedullary nails in 21 cases,and with external fixators in 63 cases.By the Cierny-Mader classification,the osteomyelitis was type Ⅰ in 21 cases,type Ⅱ in 26 cases,type Ⅲ in 366 cases,and type Ⅳ in 5 cases.We removed the internal hardware and fixated all the fractures with external fixators.For the 266 patients without bone exposure,vancomycin calcium sulfate beads (n =201) or vancomycin cement (n =65) were inset into the wounds; for the other 152 patients with bone exposure,vancomycin calcium sulfate beads were inset into the wounds which were then repaired by flap transfer.Results Follow-ups ranged from 12 to 108 months (average,37.5 months).Of the 201 patients treated with only vancomycin calcium sulfate beads,osteomyelitis was healed in 174 (86.6％) and fracture united in all (100.0％).In the 65 patients treated with only vancomycin cement,osteomyelitis was healed in 57 (87.7％) and fracture united in all (100.0％).In the 152 patients treated with vancomycin calcium sulfate beads and flap transfer,osteomyelitis was healed in 131 (86.2％) and fracture united in 147 (96.7％).Osteomyelitis was healed for the 362 patients after an average time of 3.0 months (from 2 to 14 months).Fractures united for the 413 patients after an average time of 14.0 months (from 3.5 to 20.0 months).Pin track infection was found in 23 cases.Conclusions The optimal fixation for open tibial fracture complicated with osteomyelitis is external fixators.For the wounds without soft tissue defects,vancomycin calcium sulfate beads and vancomycin cement are similar in high therapeutic efficacy.For the wounds with soft tissue defects,combination of vancomycin calcium sulfate beads and flap transfer can lead to satisfactory treatment outcomes. Key words: Fractures, open; Osteomyelitis; Vancomycin; Calcium sulfate; Cement