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[Temporary intramedullary stabilisation of infected non-union in long bones with local antibiotic-impregnated cement
1Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, Frankfurt am Main. meryemoez@gmx.de
Background:
The therapy for infected non-union is complicated and needs multidisciplinary action. The fixateur externe is usually used to stabilise an osteosynthesis temporarily or permanently. But it shows a high risk with adipose patients and when the bone is already damaged. That is why alternative modes of action have been looked for. For temporary stabilisation and simultaneous antibiotic therapy we have invented and now use a custom-made cement rod impregnated with antibiotics.
Method:
We use a plastic high-lumen thorax drainage tube which is filled with cement mixed with antibiotics and a K-wire. When the cement has set the plastic is removed. The cement rod acts as a space holder. After the infection has calmed down we remove the space holder and a definitive stabilisation with a titanium nail is performed.
Results:
The active substance levels tested in the wound exudation showed results clearly above the minimum inhibitory concentration. Early mobilisation with sole contact was mainly possible.The wound dressing could be performed without problems and an additional stabilisation was not necessary. Clinically the infection calmed down after 3 to 4 weeks.
Discussion:
The therapy for infected non-union of tubular bones consists of the complete removal of metal, the resection of the pseudarthrosis, the filling of the defect and the re-osteosynthesis. Intramedullary space holders offer a biomechanical stabilization as an intramedullary carrier of weight with additional simultaneous antibiotic therapy.
Conclusion:
The use of an intramedullary spaceholder made of antibiotic-impregnated cement in infected non-unions avoids the specific complications of a fixateur externe and is definitely more comfortable for the patient. Locally high antibiotic levels are reached, the treatment takes less time.
