Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods

Cheng Yu Fan, Ming Shium Hsieh, Wei Ming Chen, Cheng Fong Chen

研究成果: 雜誌貢獻文章

4 引文 (Scopus)

摘要

Background: Intramedullary nailing is widely accepted as the gold standard for most metaphyseal fractures of the long bones. Infections after intramedullary nailing have increased and cause recalcitrant metaphyseal osteomyelitis. Usually, multiple surgeries combined with adjuvant administration of local and systemic antibiotics are required to achieve infection control. The recurrence rate is still high and often causes poor limb function. Enhancement of local antibiotic concentrations through different delivery systems has been developed as an effective solution for eliminating musculoskeletal infections. Our study was conducted to evaluate the efficacy of antibiotic-loaded acrylic cement rods in managing infected intramedullary nailing. Methods: Twelve patients with metaphyseal osteomyelitis following intramedullary nailing were enrolled. The causative organisms were identified in eight patients, including six methicillin-resistant Staphylococcus aureus, one methicillin-susceptible S aureus, and one methicillin-resistant S aureus and Prevotella intermedia mixed infection. All patients were treated with radical reaming debridement, copious intramedullary lavage, insertion of an impregnated acrylic cement rod, and systemic antibiotic administration. Results: The average follow-up duration was 59.1 months. None of the 12 patients showed a relapse of infections. Four patients had nonunion of the old fracture site and received subsequent revisional internal fixation and bone grafting. All of them achieved solid bony union within 18 weeks. Conclusions: Insertion of antibiotic-loaded acrylic cement rods combined with adequate debridement, lavage, and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.
原文英語
頁(從 - 到)137-141
頁數5
期刊Journal of Experimental and Clinical Medicine
3
發行號3
DOIs
出版狀態已發佈 - 六月 2011

指紋

Intramedullary Fracture Fixation
Therapeutic Irrigation
Anti-Bacterial Agents
Debridement
Osteomyelitis
Infection Control
Infection
Prevotella intermedia
Recurrence
Methicillin Resistance
Methicillin
Bone Transplantation
Bone Fractures
Methicillin-Resistant Staphylococcus aureus
Coinfection
Extremities

ASJC Scopus subject areas

  • Medicine(all)

引用此文

Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods. / Fan, Cheng Yu; Hsieh, Ming Shium; Chen, Wei Ming; Chen, Cheng Fong.

於: Journal of Experimental and Clinical Medicine, 卷 3, 編號 3, 06.2011, p. 137-141.

研究成果: 雜誌貢獻文章

Fan, Cheng Yu ; Hsieh, Ming Shium ; Chen, Wei Ming ; Chen, Cheng Fong. / Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods. 於: Journal of Experimental and Clinical Medicine. 2011 ; 卷 3, 編號 3. 頁 137-141.
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abstract = "Background: Intramedullary nailing is widely accepted as the gold standard for most metaphyseal fractures of the long bones. Infections after intramedullary nailing have increased and cause recalcitrant metaphyseal osteomyelitis. Usually, multiple surgeries combined with adjuvant administration of local and systemic antibiotics are required to achieve infection control. The recurrence rate is still high and often causes poor limb function. Enhancement of local antibiotic concentrations through different delivery systems has been developed as an effective solution for eliminating musculoskeletal infections. Our study was conducted to evaluate the efficacy of antibiotic-loaded acrylic cement rods in managing infected intramedullary nailing. Methods: Twelve patients with metaphyseal osteomyelitis following intramedullary nailing were enrolled. The causative organisms were identified in eight patients, including six methicillin-resistant Staphylococcus aureus, one methicillin-susceptible S aureus, and one methicillin-resistant S aureus and Prevotella intermedia mixed infection. All patients were treated with radical reaming debridement, copious intramedullary lavage, insertion of an impregnated acrylic cement rod, and systemic antibiotic administration. Results: The average follow-up duration was 59.1 months. None of the 12 patients showed a relapse of infections. Four patients had nonunion of the old fracture site and received subsequent revisional internal fixation and bone grafting. All of them achieved solid bony union within 18 weeks. Conclusions: Insertion of antibiotic-loaded acrylic cement rods combined with adequate debridement, lavage, and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.",
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