Treatment of osteomyelitis using local bio degradable antibiotic pellets

Mohd Yusof, Nazri (2019) Treatment of osteomyelitis using local bio degradable antibiotic pellets. In: 2019 eCM XIX: Orthopaedic Infection, 26-28th June, Congress Center, Davos, Switzerland.

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Abstract

INTRODUCTION: Local antibiotic pellet using bio degradable ceramic such as calcium sulphate and calcium phosphate has been proven to be as effective as bone cement antibiotic beads in the treatment of osteomyelitis. It’s obliterate dead space and provide high concentration of local antibiotic with low systemic level thus reducing the side effect to the kidney. The main advantage of bio degradable ceramic is that it does not require second surgery for removal and its antibiotic release is more complete than the bone cement. The aim of this study is to investigate the clinical outcome of patients treated with bio degradable antibiotic pellets following debridement of osteomyelitis foci. METHODS: This was a retrospective study of 46 consecutive patients treated for osteomyelitis from 2010 till 2019. Only patients with minimal 2 years follow up were included in the study. The mean age of the patients was 28 (range 13 to 71 ) years old. Forty two (93%) were using calcium sulphate pellets and 4 patients used calcium phosphate pellets. Twenty cases due to implant related infection, 14 infected open fracture, 5 pin site infection,3 infected non-union, 3 haematogenous osteomyelitis and 1 trochanteric sore. Twenty four cases at the femur, 20 femur, and 1 at the radius and ulna. There were 3 patients stage 1A, 1 stage 1B, 1 stage IIA, 8 IIIA, 30 IVA and 3 IVB according to Cierny Mader classification. The management of osteomyelitis include debridement, local flaps (17 cases), monolateral LRS external fixation (13 cases) and ilizarov external fixation (10 cases) and bone transport (4 cases). RESULTS: Infection was resolved in 44 (96%) of patients. Thirty eight (83%) without additional surgery, 4 (9%) after bone transport and 2 (4%) after repeated debridement and insertion of local antibiotic beads. Two (4%) patients have persistence infection. A 16-year old boy with pan osteomyelitis of left femur complicated with septic dislocation of hip develop persistence sinus discharge. Another was a 21-year old man with infection following proximal femoral nailing develop persistence sinus discharge following removal of implant, reaming and antibiotic pellets. DISCUSSION & CONCLUSIONS: Bio degradable local antibiotic is an effective adjunct treatment following debridement of osteomyelitis. Repeated debridement, reinsertion of local antibiotics and bone transport helps to eradicate persistence infection ACKNOWLEDGEMENTS: This study was funded by International Islamic University of Malaysia Research Initiative Grant (RIGS 16-110-0274). REFERENCES: 1. McKee MD, Li-Bland EA, Wild LM, Schemitsch EH. A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion. J Orthop Trauma 2010;24:483–490. 2. Gitelis S , Brebach GT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant. Journal of Orthopaedic Surgery 2002, 10(1): 53–60

Item Type:	Conference or Workshop Item (Invited Papers)
Additional Information:	3756/73137
Uncontrolled Keywords:	Osteomyelitis; Antibiotic; Drug delivery; Biodegradable
Subjects:	R Medicine > RD Surgery > RD701 Orthopedics
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Department of Orthopaedics, Traumatology & Rehabilitation
Depositing User:	Nazri Mohd. Yusof
Date Deposited:	15 Jul 2019 17:11
Last Modified:	15 Jul 2019 17:11
URI:	http://irep.iium.edu.my/id/eprint/73137

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