Local use of antibiotic-impregnated calcium sulfate for infection prophylaxis: A novel study

Fracture-related infection (FRI) remains a major complication after Tibial Plateau Fracture (TPF) fixation, particularly in high-energy injuries. The efficacy of locally applied antibiotic-impregnated calcium sulfate as infection prophylaxis is unclear.

A retrospective study was conducted on 209 adult patients treated surgically for TPF from March 2010 to December 2023 at a major trauma centre. The exclusion criteria were defined as: patients under the age of 18, open fractures, compartment syndrome, pathological fractures and conservative treatment. Patients were administered either vancomycin-gentamycin impregnated calcium sulfate (Stimulan ®; n = 75) or no local antibiotic (n = 134) during fracture fixation. Infection rates (FRI Consensus Group Criteria), demographics and fracture characteristics were compared. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors.

Mean follow-up period was 21 months. FRI occurred in 18.9 % of the antibiotic group and 18.2 % of non-antibiotic group (p = 0.896). A statistically significant difference for FRI was identified between high-energy fractures (Schatzker IV-VI) and low-energy fractures (27.9 % vs 6.9 %; p < 0.001). Diabetes showed a trend toward increased FRI (p = 0.051) but was not independently significant. No calcium sulfate related complications were observed.

Local use of vancomycin and gentamycin loaded calcium sulfate in TPF fixation did not significantly reduce postoperative infection rates. High-energy fractures have been identified as the primary predictor for FRI. Further prospective studies are required to delineate the role of local antibiotic bone substitutes for infection prophylaxis after TPF fixation.