Coating the plate with antibiotic cement to treat early infection after fracture fixation with retention of the implants: a technical note

Abstract

Background: Local antibiotic therapy has gained increasing attraction in the prevention and treatment of fracture infection. However, no reports have used local antibiotic therapy in the management of early infection after fracture fixation with retention of implants.

Methods: The present surgical technique report the use of antibiotic impregnated bone cement in the management of early infection after fracture fixation. Initially, the fractures were fixed with plates. The average time from initial procedure to debridement was15 days (range 9 to 25 days). The infections were treated with irrigation, debridement, and retention of the implant. The lateral surface of the plates was coated with antibiotic cement and the bone defect was filled with antibiotic cement spacer after thorough debridement.

Results: Ten patients underwent this technique. The mean follow-up was 2.0 years (range 6 months to 4 years). The bone union rate was 100%, and the average time to bone healing was5.5 months.There was recurrence of infection in one patient before bone healing, but the implants were left in place until bone healed, and the infection was eradicated after implant removal.

Conclusion: Coating the plate with antibiotic cement is a simple technique which may play a role in the management of early infection after fracture fixation.

Keywords: Antibiotic impregnated bone cement; Fracture; Infection; Local antibiotic therapy.

Fig. 1

A 11-year-old male suffered an infection of the tibia after fracture fixation, he was treated with coated plate technique. The tibia fracture (a-b) was fixed with plate in the local hospital (c-d). He suffered an infection 9 days after surgery, the wound was breakdown and purulent drainage was seen (e). A thorough debridement was performed (f), the implant was still stable after debridement (g), therefore it was maintained and coated with antibiotic cement (h). The wound healed uneventfully after the surgery (i). The bone healed and no recurrent infection was seen at last follow-up (j-k)

Fig. 2

A 59-year-old male suffered calcaneus infection after fracture fixation, and was treated with irrigation, debridement, and retention of the implant combined with systemic and local antibiotic therapy. X-ray after fracture fixation showed the fracture was comminuted (a-b). 25 days after initial surgery, a thorough debridement was performed because of infection, two loose screws were removed, the plates were coated with antibiotic cement, and the bone defect was filled with antibiotic cement spacer (c-d). 8 months later, the bone cement(g) and the implants (h) were removed, and the cavity bone defect was filled with iliac bone grafts (i-j). At last follow- up, the bone was healed (e-f)

Fig. 3

A 64-year-old male suffered an infection of the proximal tibia 15 days after fracture fixation (a-b). A thorough debridement was performed (c). The plates were coated with antibiotic cement, and the bone defect was filled with antibiotic cement spacer (d-f). Because of compromised soft-tissue envelope, soft tissue reconstruction was performed (g). Two months later, the cement was removed from the bone defect through medial approach and the bone defect was filled with iliac bone grafts (h-i). However, the infection recurred 6 months after bone grafting (j). The implants were left in place until cortical bone healed (k-l). Then, the implants were removed and through debridement was performed, the cavity bone defect was filled with bone cement again. No recurrent infection was seen at last follow-up (m-n)