Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: nineteen consecutive cases with a minimum of 12 months follow-up.
BACKGROUND
Antibiotic cement beads are the most common system of local antibiotic delivery. Unfortunately, bead strings do not give mechanical support to the fracture site, stability being fundamental in osteomyelitis treatment. Local treatment associated with bone stability should improve the results in posttraumatic osteomyelitis. The objective of this article is to present our experience in the treatment of long bone osteomyelitis using an intramedullary, mechanically stable antibiotic dispenser.


METHODS
We present a retrospective review of a consecutive series of patients with a long bone osteomyelitis treated using an intramedullary, mechanically stable antibiotic dispenser. The dispenser used with a T-95 chest tube filled with poly(methyl methacrylate) + antibiotic (vancomycin, gentamycin, or both, tobramycin or imipenem; depending on culture results) and with a metal center (Ender nail).


RESULTS
Fifteen patients were men and three were women, with an average age of 37 years (range, 18-52 years). In four cases, treatment involved the femur and in 15 the tibia. Positive cultures were obtained from each patient. Methicillin-resistant Staphylococcus aureus was isolated in 17 cases. The intramedullary dispenser was removed between 6 and 76 weeks after surgery. Success was defined as negative cultures after dispenser removal. Follow-up period was between 10 and 54 months. Negative cultures were obtained from intramedullary reaming after dispenser removal in all but one patient who could not finish treatment because of local intolerance to antibiotic treatment. None of the 17 patients presented an infection recurrence.


CONCLUSIONS
The combination of local antibiotic treatment with bone segment stability showed acceptable results in our short series of patients. Further investigation on locked intramedullary antibiotic dispensers providing improved stability will help us learn about this difficult clinical scenario.
Sancineto
Carlos Federico
CF
Hospital Italiano de Buenos Aires, Argentina.
Barla
Jorge Daniel
JD
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001858:Bone Nails; D015505:Chest Tubes; D003646:Debridement; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005599:Fractures, Ununited / Q000188:drug therapy; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy*; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D019904:Polymethyl Methacrylate