Effectiveness of Antibiotic Cement-Coated Rods in the Management of Chronic Post-traumatic Osteomyelitis

Chronic post-traumatic osteomyelitis (CPTO) remains a challenging orthopedic condition characterized by persistent infection, bone destruction, and delayed healing.

This study aimed to evaluate the short-term effectiveness of locally fabricated antibiotic cement-coated rods in infection control and bone healing among patients with CPTO of the femur and tibia.

This descriptive study was conducted at the Department of Orthopedics, Hayatabad Medical Complex, Peshawar, Pakistan, from September 9, 2022, to March 9, 2023. A total of 126 patients aged 18-60 years with CPTO were included using consecutive non-probability sampling. Patients with non-union, segmental bone defects, or Cierny-Mader type IV osteomyelitis were excluded. All patients underwent standardized surgical debridement followed by the insertion of antibiotic cement-coated intramedullary rods prepared intraoperatively with vancomycin (2 g) and gentamicin (0.5 g) per 40 g of cement. Postoperative antibiotics were adjusted according to intraoperative culture and sensitivity results. Clinical and radiological assessments were performed at three and six weeks and at three months. Data were analyzed using IBM SPSS Statistics software, version 24 (IBM Corp., Armonk, NY).

Of 126 patients, 77 (61.11%) were male and 49 (38.89%) female, with a mean age of 40.07 ± 11.44 years. The femur was involved in 96 patients (76.19%), and the tibia in 30 patients (23.81%). Treatment was effective in 108 patients (85.71%), while 18 patients (14.29%) experienced persistence or recurrence of infection. Pain relief improved from 78 patients (61.90%) at three weeks to 110 (87.30%) at three months. Sinus discharge resolved in 112 patients (88.89%) at three months. Radiologically, callus formation increased from 52 patients (41.27%) at three weeks to 101 (80.16%) at three months, and the absence of sequestrum improved from 90 (71.43%) to 113 (89.68%).

Antibiotic cement-coated rods demonstrate high short-term effectiveness in infection control and bone healing in CPTO. However, further multicenter studies with longer follow-up and standardized microbiological reporting are warranted to confirm long-term efficacy and reproducibility.