Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod.

OBJECTIVES

This study looks at the treatment of 16 cases of infection in long bone fractures that had an adverse effect on healing. The goal was to find a method that may be effective in getting these most difficult injuries to heal. The use of reinforced antibiotic-impregnated bone cement rods was studied to see if this could be an effective form of treatment. The use of such devices makes sense because they provide stability that the fractures need for healing while also providing a high concentration of antibiotics locally. The concept was to reduce the amount of metal used for stability while still giving the fracture the correct milieu for healing.

DESIGN

This was a retrospective analysis of 16 patients with infected nonunions of long bones. A protocol for the use of intravenous and per oral antibiotics was developed based on the type of bacteria found from cultures of the infected sites. All cases included operative débridement and stabilization with a reinforced antibiotic-impregnated bone cement rod.

PATIENTS

The patient population was selected from all those who presented to the Department of Orthopaedic Surgery of Dayanand Medical College & Hospital, Ludhiana, India.

MAIN OUTCOME

Success was considered when the nonunion healed and the limb became functional.

RESULTS

The infected nonunions were treated successfully in 14 of 16 cases. This represents an alternative to external fixation alone as a means of stabilizing nonunions while providing a high concentration of antibiotic locally for combating this most difficult problem.

CONCLUSIONS

The use of reinforced antibiotic-impregnated bone cement rods with appropriate surgical débridement and antibiotics may be an effective way of treating infected nonunions of long bones.

LEVEL OF EVIDENCE

Therapeutic Level IV. See page 128 for a complete description of levels of evidence.