title: Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion.
abstract: BACKGROUND
  Bone grafting plays a critical role in promoting bone healing in infected nonunion, although recurrent infection is of concern. Cancellous bone grafting as an antibiotic delivery system has been reported as an effective method to combat infections. In this study, we report the clinical results of vancomycin-impregnated cancellous bone grafting for the treatment of infected tibial nonunion.
  
  
  METHODS
  Between January 1996 and March 2001, 18 patients with infected tibial nonunion treated with vancomycin-impregnated cancellous bone grafting were available for follow-up. According to the Cierny-Mader classification, all patients belonged to type IVA and IVB osteomyelitis. Adequate debridement, stabilization with external fixation, and staged vancomycin-impregnated cancellous bone grafting were used in all patients. Regular clinical and radiographic follow-ups were conducted.
  
  
  RESULTS
  Infection control was obtained in all 18 patients with a 100% infection arrest rate. Bone union was achieved in 13 of 18 patients at an average of 5.8 months. Bone union was obtained subsequently in the remaining five patients after closed nailing in four, and plating and bone grafting in one patient. Radiographs showed good consolidation and hypertrophy of grafted bone at an average follow-up of 48 months.
  
  
  CONCLUSIONS
  We conclude that vancomycin-impregnated cancellous bone grafting is a safe method for the treatment of infected tibial nonunion.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-sung Hsiang, 83305, Kaohsiung Hsien, Taiwan, ROC. chinenmd@ms21.hinet.net
authors.forename: Chin-En
authors.initials: CE
authors.lastname: Chen
authors.forename: Jih-Yang
authors.initials: JY
authors.lastname: Ko
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement; D005260:Female; D005592:Fracture Fixation; D005599:Fractures, Ununited / Q000209:etiology / Q000628:therapy*; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008768:Methylmethacrylates / Q000008:administration & dosage; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000628:therapy*; D007507:Therapeutic Irrigation; D013978:Tibial Fractures / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead; D014640:Vancomycin