[Antibiotic-impregnated cement temporary spacer for surgical treatment of osteomyelitis and nonunion of bone caused by intramedullary nailing].

OBJECTIVE

To discuss the effectiveness of antibiotic-impregnated cement temporary spacer for osteomyelitis and nonunion of bone caused by intramedullary fixation.

METHODS

Between June 2002 and May 2006, 12 patients with chronic osteomyelitis and nonunion of bone caused by intramedullary nailing were treated, including 8 males and 4 females with an average age of 40.2 years (range, 26-53 years). The fracture locations included tibia in 7 cases and femur in 5 cases. Infection occurred within 2 weeks after intramedullary fixation in 7 cases and within 3 months in 5 cases. The mean time from infection to admission was 5 months (range, 1-24 months). The results of bacteria culture were positive in 10 cases and negative in 2 cases. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were higher than normal values. An antibiotic-impregnated cement temporary spacer was inserted after removal of biomembrane and internal fixator, thorough debridement and irrigation. After osteomyelitis was controlled by antibiotic therapy postoperatively, two-stage bone transplantation and internal fixation were performed after 3 to 6 months.

RESULTS

All wounds healed by first intention without early complication. All cases were followed up 24 to 48 months (mean, 34 months). WBC count, ESR, and CRP were normal at 3 months postoperatively. The X-ray films showed the fracture healing at 10-14 weeks after operation (mean, 12 weeks). Expect one patient had knee range of motion of 90 degrees, the lower limb function of the others returned to normal. No infection recurred during follow-up.

CONCLUSION

Antibiotic-impregnated cement temporary spacer could control osteomyelitis and nonunion of bone caused by intramedullary nailing, and two-stage bone transplantation and internal fixation after osteomyelitis is an effective and ideal way to treat osteomyelitis and nonunion of bone caused by intramedullary nailing.