Treatment of osteomyelitis using local bio degradable antibiotic pellets

Treatment of osteomyelitis using local bio degradable antibiotic pellets

INTRODUCTION: Local antibiotic pellet using bio degradable ceramic such as calcium sulphate and calcium phosphate has been proven to be as effective as bone cement antibiotic beads in the treatment of osteomyelitis. It’s obliterate dead space and provide high concentration of local antibiotic with l...

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Main Author: Mohd Yusof, Nazri
Format: Conference or Workshop Item
Language:English
Published: AO Research Institute Davos 2019
Subjects:
RD701 Orthopedics
Online Access:http://irep.iium.edu.my/73137/
http://irep.iium.edu.my/73137/
http://irep.iium.edu.my/73137/1/73137_TREATMENT%20OF%20OSTEOMYELITIS_complete.pdf
id iium-73137
recordtype eprints
spelling iium-731372019-07-15T09:11:36Z http://irep.iium.edu.my/73137/ Treatment of osteomyelitis using local bio degradable antibiotic pellets Mohd Yusof, Nazri RD701 Orthopedics INTRODUCTION: Local antibiotic pellet using bio degradable ceramic such as calcium sulphate and calcium phosphate has been proven to be as effective as bone cement antibiotic beads in the treatment of osteomyelitis. It’s obliterate dead space and provide high concentration of local antibiotic with low systemic level thus reducing the side effect to the kidney. The main advantage of bio degradable ceramic is that it does not require second surgery for removal and its antibiotic release is more complete than the bone cement. The aim of this study is to investigate the clinical outcome of patients treated with bio degradable antibiotic pellets following debridement of osteomyelitis foci. METHODS: This was a retrospective study of 46 consecutive patients treated for osteomyelitis from 2010 till 2019. Only patients with minimal 2 years follow up were included in the study. The mean age of the patients was 28 (range 13 to 71 ) years old. Forty two (93%) were using calcium sulphate pellets and 4 patients used calcium phosphate pellets. Twenty cases due to implant related infection, 14 infected open fracture, 5 pin site infection,3 infected non-union, 3 haematogenous osteomyelitis and 1 trochanteric sore. Twenty four cases at the femur, 20 femur, and 1 at the radius and ulna. There were 3 patients stage 1A, 1 stage 1B, 1 stage IIA, 8 IIIA, 30 IVA and 3 IVB according to Cierny Mader classification. The management of osteomyelitis include debridement, local flaps (17 cases), monolateral LRS external fixation (13 cases) and ilizarov external fixation (10 cases) and bone transport (4 cases). RESULTS: Infection was resolved in 44 (96%) of patients. Thirty eight (83%) without additional surgery, 4 (9%) after bone transport and 2 (4%) after repeated debridement and insertion of local antibiotic beads. Two (4%) patients have persistence infection. A 16-year old boy with pan osteomyelitis of left femur complicated with septic dislocation of hip develop persistence sinus discharge. Another was a 21-year old man with infection following proximal femoral nailing develop persistence sinus discharge following removal of implant, reaming and antibiotic pellets. DISCUSSION & CONCLUSIONS: Bio degradable local antibiotic is an effective adjunct treatment following debridement of osteomyelitis. Repeated debridement, reinsertion of local antibiotics and bone transport helps to eradicate persistence infection ACKNOWLEDGEMENTS: This study was funded by International Islamic University of Malaysia Research Initiative Grant (RIGS 16-110-0274). REFERENCES: 1. McKee MD, Li-Bland EA, Wild LM, Schemitsch EH. A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion. J Orthop Trauma 2010;24:483–490. 2. Gitelis S , Brebach GT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant. Journal of Orthopaedic Surgery 2002, 10(1): 53–60 AO Research Institute Davos 2019-06 Conference or Workshop Item PeerReviewed application/pdf en http://irep.iium.edu.my/73137/1/73137_TREATMENT%20OF%20OSTEOMYELITIS_complete.pdf Mohd Yusof, Nazri (2019) Treatment of osteomyelitis using local bio degradable antibiotic pellets. In: 2019 eCM XIX: Orthopaedic Infection, 26-28th June, Congress Center, Davos, Switzerland. http://www.ecmconferences.org/abstracts/2019/Collection5/posters.pdf
repository_type Digital Repository
institution_category Local University
institution International Islamic University Malaysia
building IIUM Repository
collection Online Access
language English
topic RD701 Orthopedics
spellingShingle RD701 Orthopedics
Mohd Yusof, Nazri
Treatment of osteomyelitis using local bio degradable antibiotic pellets
description INTRODUCTION: Local antibiotic pellet using bio degradable ceramic such as calcium sulphate and calcium phosphate has been proven to be as effective as bone cement antibiotic beads in the treatment of osteomyelitis. It’s obliterate dead space and provide high concentration of local antibiotic with low systemic level thus reducing the side effect to the kidney. The main advantage of bio degradable ceramic is that it does not require second surgery for removal and its antibiotic release is more complete than the bone cement. The aim of this study is to investigate the clinical outcome of patients treated with bio degradable antibiotic pellets following debridement of osteomyelitis foci. METHODS: This was a retrospective study of 46 consecutive patients treated for osteomyelitis from 2010 till 2019. Only patients with minimal 2 years follow up were included in the study. The mean age of the patients was 28 (range 13 to 71 ) years old. Forty two (93%) were using calcium sulphate pellets and 4 patients used calcium phosphate pellets. Twenty cases due to implant related infection, 14 infected open fracture, 5 pin site infection,3 infected non-union, 3 haematogenous osteomyelitis and 1 trochanteric sore. Twenty four cases at the femur, 20 femur, and 1 at the radius and ulna. There were 3 patients stage 1A, 1 stage 1B, 1 stage IIA, 8 IIIA, 30 IVA and 3 IVB according to Cierny Mader classification. The management of osteomyelitis include debridement, local flaps (17 cases), monolateral LRS external fixation (13 cases) and ilizarov external fixation (10 cases) and bone transport (4 cases). RESULTS: Infection was resolved in 44 (96%) of patients. Thirty eight (83%) without additional surgery, 4 (9%) after bone transport and 2 (4%) after repeated debridement and insertion of local antibiotic beads. Two (4%) patients have persistence infection. A 16-year old boy with pan osteomyelitis of left femur complicated with septic dislocation of hip develop persistence sinus discharge. Another was a 21-year old man with infection following proximal femoral nailing develop persistence sinus discharge following removal of implant, reaming and antibiotic pellets. DISCUSSION & CONCLUSIONS: Bio degradable local antibiotic is an effective adjunct treatment following debridement of osteomyelitis. Repeated debridement, reinsertion of local antibiotics and bone transport helps to eradicate persistence infection ACKNOWLEDGEMENTS: This study was funded by International Islamic University of Malaysia Research Initiative Grant (RIGS 16-110-0274). REFERENCES: 1. McKee MD, Li-Bland EA, Wild LM, Schemitsch EH. A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion. J Orthop Trauma 2010;24:483–490. 2. Gitelis S , Brebach GT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant. Journal of Orthopaedic Surgery 2002, 10(1): 53–60
format Conference or Workshop Item
author Mohd Yusof, Nazri
author_facet Mohd Yusof, Nazri
author_sort Mohd Yusof, Nazri
title Treatment of osteomyelitis using local bio degradable antibiotic pellets
title_short Treatment of osteomyelitis using local bio degradable antibiotic pellets
title_full Treatment of osteomyelitis using local bio degradable antibiotic pellets
title_fullStr Treatment of osteomyelitis using local bio degradable antibiotic pellets
title_full_unstemmed Treatment of osteomyelitis using local bio degradable antibiotic pellets
title_sort treatment of osteomyelitis using local bio degradable antibiotic pellets
publisher AO Research Institute Davos
publishDate 2019
url http://irep.iium.edu.my/73137/
http://irep.iium.edu.my/73137/
http://irep.iium.edu.my/73137/1/73137_TREATMENT%20OF%20OSTEOMYELITIS_complete.pdf
first_indexed 2023-09-18T21:43:42Z
last_indexed 2023-09-18T21:43:42Z
_version_ 1777413309490790400

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