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Locally Delivered Antibiotics in Fracture-Related Infection
Henry Mills1, Liam Donnelly2, Simon Platt1
1Orthopaedics, Gold Coast University Hospital, Gold Coast, AUS.
Abstract:
The prevention and treatment of fracture-related infections (FRIs) pose significant challenges in orthopaedic trauma care, with current practices predominantly relying on systemic antibiotic administration. However, locally delivered antibiotics achieve substantially higher tissue concentrations and minimise systemic side effects. Whilst extensively researched in periprosthetic joint infections (PJIs), the use of local delivery methods is increasingly prevalent in FRI prevention and treatment. Various local delivery methods such as powders, aqueous injections and carriers such as cement, bone graft, bioceramics, polymers and hydrogels have been explored. Biodegradable antibiotic carriers offer a promising alternative to non-absorbable carriers (i.e., cement), which necessitate surgical removal. There is good evidence for the use of local antibiotics in preventing and treating FRI, particularly in high-risk fractures or in treating more severe, resistant infections. Despite theoretical concerns, reports of adverse events in human studies are rare. To enhance our understanding of the safety and efficacy of these methods across various fracture patterns, further prospective randomised controlled trials are warranted. This article describes the current strategies and methodologies for FRI prevention and treatment and reviews the existing evidence base.
Insights
Local antibiotics offer superior fracture-related infection (FRI) prevention and treatment compared to systemic methods. Biodegradable carriers are promising, with rare adverse events reported in human studies.
Area of Science:
- Orthopaedic Trauma Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Fracture-related infections (FRIs) present significant challenges in orthopaedic trauma care.
- Current treatments primarily use systemic antibiotics, which have limitations.
- Local antibiotic delivery offers higher tissue concentrations and fewer systemic side effects, gaining traction for FRIs.
Purpose of the Study:
- To review current strategies and evidence for local antibiotic delivery in preventing and treating FRIs.
- To highlight the benefits of local antibiotic delivery over systemic administration.
- To discuss various local delivery methods and carriers, including biodegradable options.
Main Methods:
- Review of existing literature on local antibiotic delivery for FRIs.
- Analysis of different antibiotic delivery systems: powders, injections, and carriers (cement, bone graft, bioceramics, polymers, hydrogels).
- Evaluation of evidence for safety and efficacy, particularly comparing biodegradable and non-absorbable carriers.
Main Results:
- Local antibiotic delivery demonstrates good evidence for FRI prevention and treatment, especially in high-risk or severe infections.
- Biodegradable carriers are a promising alternative to non-absorbable carriers like cement.
- Adverse events in human studies are rare, despite theoretical concerns.
Conclusions:
- Local antibiotic delivery is effective and safe for managing FRIs.
- Biodegradable carriers represent an advancement in local antibiotic delivery systems.
- Further prospective randomized controlled trials are needed to confirm safety and efficacy across diverse fracture types.
