Antibiotic Cement-Coated Plates for Management of Infected Fractures
Deep infection in the presence of an implant after open reduction and internal fixation is usually treated with removal of the implant, serial débridement procedures, lavage, intravenously administered antibiotics, and occasionally, placement of antibiotic-impregnated beads. If infection occurs during the early stages of bone healing, fracture stabilization might be compromised after implant removal.
Osteomyelitis, unstable owing to a bone deficit or fracture, was treated with an antibiotic cement–coated (tobramycin and vancomycin) plate. The goal was successful eradication of infection with the patient remaining infection-free for 1 year. Four patients were treated with antibiotic-coated plates for osteomyelitis and all have achieved successful union, clinically free of signs of infection for more than 1 year. One patient experienced a prominent and painful plate, necessitating removal.
Based on our experience, early aggressive débridement coupled with broad-spectrum antibiotic cement–coated plate insertion, provides fracture stability and helps eradicate the infection with 1 surgical procedure.
Broad-spectrum antibiotics are used to coat the plate in order to cover as many microbial organisms as possible without knowing the final offending organism. In our experience, this current technique provides antibiotic delivery with bony stability, therefore eliminating the need for multiple sequential surgical procedures. This difficult patient problem does not occur with enough frequency to warrant a large randomized clinical trial. However, this technique has been effective in these cases and may be useful to orthopedic surgeons in the future.
Conclusion
Based on our experience, early aggressive débridement, coupled with broad-spectrum antibiotic cement–coated plate insertion, provides fracture stability and helps eradicate the infection with 1 surgical procedure.
