title: Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature.
abstract: The use of local antibiotics for the prevention of infection in the setting of open fractures and as part of the treatment of osteomyelitis is well established. Antibiotics are most commonly incorporated into polymethylmethacrylate (PMMA) cement, which can then be formed into beads, moulded to fit a bone defect or used to coat a guide wire or IM nail. Newer delivery vehicles and techniques are being evaluated to improve upon these methods. Many factors influence how local antibiotics are applied. Treatment strategies are challenging to standardise due to the variability of clinical presentations. The presence of hardware, upper versus lower extremity, healed versus non-healed fracture and quality of soft tissues overlying the affected bone, as well as patients' comorbidities all need to be considered. Despite the accepted use of local antibiotic therapy in orthopaedic trauma, high-quality evidence regarding the use of local antibiotics is lacking. Indications, techniques, dosages, types of antibiotics, elution properties and pharmacokinetics are poorly defined in the clinical setting. The purpose of our manuscript is to review current strategies and provide practical tips for local application of antibiotics in orthopaedic trauma. We focus on delivery vehicles, types of antibiotics, dosage recommendations when mixed with PMMA and indications.
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hake
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hak
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: E Mark
authors.initials: EM
authors.lastname: Hammerberg
authors.affiliation: Department of Orthopaedics, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA. Electronic address: cyril.mauffrey@dhha.org.
authors.forename: Cyril
authors.initials: C
authors.lastname: Mauffrey
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001843:Bone Cements / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems / Q000639:trends; D005597:Fractures, Open / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D035002:Lower Extremity / Q000293:injuries; D010019:Osteomyelitis / Q000188:drug therapy*; D019904:Polymethyl Methacrylate / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D034941:Upper Extremity / Q000293:injuries
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D003692:Delayed-Action Preparations; D019904:Polymethyl Methacrylate
keywords: Antibiotic cement nails; Antibiotic-loaded cement; Local antibiotics; Open fractures; Osteomyelitis; PMMA beads