title: Antibiotic cement-coated rods: an effective treatment for infected long bones and prosthetic joint nonunions.
abstract: The treatment of infected nonunions is difficult. Antibiotic cement-coated (ACC) rods provide stability as well as delivering antibiotics. We conducted a review of 110 infected nonunions treated with ACC rods. Patients were divided into two groups: group A (67 patients) with an infected arthrodesis, and group B (43 patients) with an infected nonunion in a long bone. In group A, infected arthrodesis, the success rate after the first procedure was 38/67 (57%), 29/67 (43%) required further surgery for either control of infection or non-union. At last follow-up, five patients required amputation, representing a limb salvage rate of 62/67 (93%) overall. In all, 29/67 (43%) presented with a bone defect with a mean size of 6.78 cm (2 to 25). Of those with a bone defect, 13/29 (45%) required further surgery and had a mean size of defect of 7.2 cm (3.5 to 25). The cultures were negative in 17/67 (26%) and the most common organism cultured was methicillin-resistant staphylococcus aureus (MRSA) (23/67, (35%)). In group B, long bones nonunion, the success rate after the first procedure was 26/43 (60%), 17/43 (40%) required further surgery for either control of infection or nonunion. The limb salvage rate at last follow-up was 43/43 (100%). A total of 22/43 (51%) had bone defect with a mean size of 4.7 cm (1.5 to 11.5). Of those patients with a bone defect, 93% required further surgery with a mean size of defect of 5.4 cm (3 to 8.5). The cultures were negative in 10/43 (24%) and the most common organism cultured was MRSA, 15/43 (35%). ACC rods are an effective form of treatment for an infected nonunion, with an acceptable rate of complications.
authors.affiliation: International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, Maryland, 21215, USA.
authors.forename: J
authors.initials: J
authors.lastname: Conway
authors.affiliation: International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, Maryland, 21215, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mansour
authors.affiliation: International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, Maryland, 21215, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kotze
authors.affiliation: International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, Maryland, 21215, USA.
authors.forename: S
authors.initials: S
authors.lastname: Specht
authors.affiliation: International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, Maryland, 21215, USA.
authors.forename: L
authors.initials: L
authors.lastname: Shabtai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001174:Arthrodesis / Q000009:adverse effects; D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D003646:Debridement / Q000379:methods; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D020099:Coated Materials, Biocompatible
keywords: Antibiotic; Infection; Non-union; Rods; Cement; Infected