title: Antibiotic-impregnated calcium sulfate use in combat-related open fractures.
abstract: This article presents our experience with the use of antibiotic-impregnated calcium sulfate in the management of comminuted open fractures with a bony defect caused by combat-related blast injuries and high-energy wounds. Calcium sulfate was used 19 times in 15 patients (17 fractures) as a bone graft substitute and a carrier for antibiotics. The anatomic sites of the graft were as follows: 6 calcanei, 1 midfoot, 1 metatarsal, 5 tibiae, 3 femorae, and 1 humerus. The average number of procedures prior to grafting was 6.2 (range, 2-10; median, 6) with grafting performed at an average 28 days after injury (range, 9-194 days; median, 14 days). Average radiographic follow-up of 12 fractures not requiring repeat grafting or amputation was 8.5 months (range 1-19 months; median, 7 months), and all of these fractures demonstrated clinical and radiographic evidence of fracture healing and consolidation. Four patients subsequently underwent 5 transtibial amputations: 2 for persistent infection, 1 when the patient changed his mind against limb salvage acutely, and 2 for severe neurogenic pain. Including the 2 amputations for persistent infection, 4 patients (22.2%) required further surgical management of infection. Three patients (17.6%) subsequently developed heterotopic ossification at the graft site, which required surgical excision. Antibiotic-impregnated calcium sulfate is effective in treating severe, contaminated open fractures by reducing infection and assisting with fracture union.
authors.affiliation: Department of Orthopedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Ave, Washington, DC 20307, USA.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Helgeson
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Tucker
authors.forename: H Michael
authors.initials: HM
authors.lastname: Frisch
authors.forename: Scott B
authors.initials: SB
authors.lastname: Shawen
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001753:Blast Injuries / Q000188:drug therapy* / Q000601:surgery*; D001843:Bone Cements / Q000627:therapeutic use*; D002133:Calcium Sulfate / Q000627:therapeutic use*; D004337:Drug Carriers / Q000008:administration & dosage*; D005260:Female; D005597:Fractures, Open / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D010019:Osteomyelitis / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004337:Drug Carriers; D002133:Calcium Sulfate