Management of infected Non Union of Long Bones by Antibiotic Loaded PMMA Cement Coated Nail and Beads

Vijayanth, K (2009) Management of infected Non Union of Long Bones by Antibiotic Loaded PMMA Cement Coated Nail and Beads. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Ununited fractures of long bones are not only a complex surgical problem but also a chronic and at times debilitating condition. Infected non-union of long bones are not only a source of functional disability but also lead to economical hardship and loss of self esteem. Infected non-union has been defined as a state of failure of union for 6-8 months with persistent infection at the fracture site. Infected non-union can develop after an open fracture, after a previous Open Reduction and Internal Fixation (ORIF) or as sequelae to chronic haematogenous osteomyelitis. The incidence also seems to be increasing especially in view of increasing high velocity trauma, which is more frequently treated with internal fixation. The advantages of antibiotic impregnated PMMA coated nails and beads in the treatment of infected non union of long bones being increased local concentration of antibiotics and stable internal fixation, which controls infection and promotes bony healing at a better rate with good patient compliance. AIM: 1. To discuss the biological advantage of antibiotic cemented nailing and beads in the management of infection non union of long bones. 2. To evaluate the clinical outcome of the study and discuss the results of cases with infected non-union of femur and tibia managed by antibiotic impregnated PMMA cemented Rods and Beads. MATERIALS AND METHODS: A prospective study of 20 patients of infected non-union of long bones of lower limb managed by antibiotic cement loaded nails and beads were done. The period of study and follow up extends from November 2006 to November 2008 at Government Rajaji Hospital, Madurai. We took infected non union of femur and Tibia in our study. Inclusion Criteria: 1. Mild and moderate infection (according to Kulkarni’s classification), 2. Shortening < 2 cm, 3. With no deformity, 4. Age group between 25 and 50 years. Exclusion criteria: 1. Severe infection, 2. Shortening > 2 cm, 3. With deformity, 4. With poor skin and soft tissue condition, 5. Age < 25 years and > 50 years, 6. Previous multiple failed procedures. The basic surgical technique in my study as discussed earlier included the removal of infected nail , debridement and irrigation of medullary canal, preparation of Vancomycin loaded PMMA cemented nail and beads, insertion of antibiotic cemented nail into the medullary canal and implantation of beads at infected site. Post operatively the beads were removed in most of the cases at 4 to 6 weeks interval; and 4 patients did not turn out for early beads removal and beads removal was done at 8 to 10 weeks interval. Bone grafting was done in 12 cases. We followed the cases for 12 to 24 months period. All cases united with an average time of 4.5 months. In 4 cases infection persisted in spite of union which required further procedures. RESULTS: 85% of patients were male. o 50% of patients were between 25-35 year age group o Right side was more common o Femur infected non-union (80%) more reported than Tibia non-union cases o Average time interval between primary procedure and antibiotic cemented nailing was 8 months o Average time for bone union was 4 ½ months o Overall percentage of complications was low compared to other methods o 60% of patients required bone grafting. o 95 % of patients went on for union. o In 20 % of patients infection persisted in spite of union. CONCLUSION: Control of infection and stability to promote union in infected non-union of femur and tibia has traditionally been provided by multiple surgical procedures which have proved to be not efficacious, with poor cooperation and compliance from patients. However the single staged procedure of antibiotic cemented nailing has achieved the goals of infection control and fracture union with good patient compliance. It avoids systemic toxicity of antibiotics, provides high concentration of local antibiotics and avoids multiple procedures with good patient compliance. Hence we conclude that antibiotic cemented rods and beads could be a relatively effective, simple and inexpensive method of treating intramedullary infections.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Management ; infected Non Union of Long Bones ; Antibiotic Loaded PMMA Cement Coated Nail ; Beads.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:44
Last Modified: 17 Sep 2017 06:10

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