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Use of gentamicin-loaded collagen sponge in internal fixation of open fractures
Susheel Chaudhary1, Ramesh-K Sen, Uttam-Chand Saini
1Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Insights
Immediate plate osteosynthesis with local antibiotic-releasing collagen fleeces is a safe and effective treatment for open fractures. This method promotes bone union and minimizes deep infections, avoiding implant removal.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Infectious Disease Prevention
Background:
- Open fractures present a significant challenge in trauma care.
- Effective infection control and bone union are critical for successful outcomes.
- Traditional treatments may involve multiple surgeries and prolonged recovery.
Purpose of the Study:
- To evaluate the efficacy of immediate plate osteosynthesis combined with antibiotic-impregnated collagen fleeces in treating open fractures.
- To assess the rates of bone union, infection, and other complications.
Main Methods:
- A cohort of 35 patients with open fractures treated within 6 hours of injury.
- Immediate open reduction and plate fixation with debridement.
- Application of gentamicin-collagen or antibiotic sponges around the fixation device.
- Follow-up assessment for infection, union, and complications.
Main Results:
- 31 patients had adequate follow-up (mean 40 weeks).
- Excellent bone union rates were observed.
- Low rates of superficial (9.67%) and deep (6.45%) infections were reported.
- Delayed union occurred in 16.13% of patients; no nonunions or implant failures were noted.
Conclusions:
- Immediate plate osteosynthesis with local antibiotic delivery is a safe and effective technique for open fractures.
- The use of bioabsorbable antibiotic sponges simplifies the procedure and avoids secondary surgery.
- This approach offers promising results for managing open bone injuries.
Objective:
To assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces (gentamicin-collagen and antibiotic sponge) which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury.
Methods:
All cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irrigation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Patients were assessed to determine postoperative infection, delayed union or nonunion and development of other postoperative complications. It was hypothesized that immediate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures.
Results:
The 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks (15-160 weeks). Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complications (superficial infection and skin loss) were found in 3 patients (9.67%). Deep infection was noted in 2 patients (6.45%). None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients (16.13%). No patient progressed to nonunion or implant failure in long term follow-up. Excessive scarring was developed in 2 patients (6.45%).
Conclusions:
Immediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.
