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. 2025 Aug 15;8(3):e415.
doi: 10.1097/OI9.0000000000000415. eCollection 2025 Sep.

Osseous union after antibiotic cement application with retention of stable orthopaedic hardware in fracture-related infections without union

Devone Mansour  1   2 , Hunter Ross  1   2 , Tannor Court  1   2 , Daniel Cavazos  1   2 , Trey D VanAken  1 , Rahul Vaidya  1   2
Affiliations

Osseous union after antibiotic cement application with retention of stable orthopaedic hardware in fracture-related infections without union

Devone Mansour et al. OTA Int. .

Abstract

Objective: To evaluate treatment outcomes of patients treated with antibiotic impregnated cement applied over implanted orthopaedic hardware, in the setting of fracture-related infection, without osseous union, after open reduction internal fixation.

Design: Retrospective observational case series.

Setting: Level 1 trauma center.

Patients/participants: Retrospective review of 15 patients who underwent antibiotic cement application to their retained plate for the treatment of acute fracture-related infections (12) and acutely infected nonunion (3) status after open reduction internal fixation (ORIF).

Outcomes: Suppression of infection and radiographic union by final follow-up.

Results: Antibiotic plate application successfully led to fracture union in all 15 patients (100%). Three of these patients (20%) required removal of hardware. Of these 3 patients, all 3 achieved fracture union before hardware removal. However, 2 of these patients developed a chronic infection and were placed on long term PO antibiotics for chronic infection suppression, thus making them ineligible for classification as free of infection.

Conclusions: The results of this study suggest that application of antibiotic cement to retained plates/screws for ORIF during treatment of both acute fracture infections and acutely infected nonunions is a viable technique to achieve osseous union. Hardware removal may be required in some cases. Use of this technique supports fracture healing and local infection control, while maintaining construct stability long enough to achieve fracture union.

Keywords: ORIF; antibiotic cement; antibiotic plate; fracture; infection; nonunion.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
(A) Initial fracture radiograph and (B) radiograph at the time of infection diagnosis of a patient with an acute fracture infection.
Figure 2.
Figure 2.
(A) Initial fracture radiograph and (B) radiograph demonstrating nonunion of a patient with an acutely infected nonunion.
Figure 3.
Figure 3.
(A) Radiograph taken immediately after antibiotic cement placement and (B) radiograph demonstrating osseous union after antibiotic cement placement in a patient with an acute fracture infection.
Figure 4.
Figure 4.
(A) Radiograph taken immediately after antibiotic cement placement and (B) radiograph demonstrating osseous union, after antibiotic cement placement in a patient with an acutely infected nonunion.
See this image and copyright information in PMC

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