[Treatment of lower limb osteomyelitis by a local bone substitute supplemented with antibiotics]

A seriously injured tsunami victim with complicated osteomyelitis is presented. The patient was treated with a new resorbable bone substitute, which can be loaded with different antibiotics. The successful treatment is illustrated by the clinical, radiological and histological features. Bilateral open fractures of the lower leg with open elbow fracture led to a bilateral amputation of the lower legs and the right arm because of a beginning sepsis. The following intramedullary osteitis with multiresistant Pseudomonas aeruginosa, Escherichia coli and Enterococcus faecium was treated with the bone substitute PerOssal combined with systemic and local application of vancomycin and systemic application of ceftazidime and meropenem. This case report illustrates the concept of an additional local antibiotic treatment of osteomyelitis by a bone substitute also functioning as a drug delivery system.