title: Treatment of infected tibial nonunion with tobramycin-impregnated calcium sulfate: report of two cases.
abstract: The treatment of infected tibial nonunion usually includes a staged reconstruction protocol. We present 2 patients with tibial nonunion and plate loosening with oxacillin-resistant Staphylococcus aureus infection. The patients were treated using the removal of the plate, radical debridement, and implantation of gentamycin-impregnated cement beads during the first stage. During the second stage, plate fixation was performed and tobramycin-impregnated calcium sulfate (Osteoset T) was used as a bone graft substitute. Neither an autogenous bone graft nor an allograft was used. At 3 years of follow-up, each tibia showed good union, and there was no recurrence of infection. We consider tobramycin-impregnated calcium sulfate to be an alternative method of bone grafting to treat infected tibial nonunion.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan 613, ROC.
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Tsai
authors.forename: Huang
authors.initials: H
authors.lastname: Tsung-Jen
authors.forename: Hsin-Nung
authors.initials: HN
authors.lastname: Shih
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
mesh_terms: D000059:Accidents; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002133:Calcium Sulfate / Q000627:therapeutic use*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013977:Tibia / Q000187:drug effects / Q000382:microbiology / Q000601:surgery; D013978:Tibial Fractures / Q000150:complications / Q000628:therapy; D014031:Tobramycin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D014031:Tobramycin; D002133:Calcium Sulfate