Abstract

LUGONES, Alfonso; PAGANINI, Federico; FATTOR, Emanuel  and  ALLENDE, Bartolomé L.. Antibiotic-impregnated polymethylmethacrylate in the treatment of infected nonunions and segmental bone defects. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2009, vol.74, n.3, pp.249-257. ISSN 1852-7434.

Background: Treatment of bone infections is variable and includes: removal of osteosynthesis, surgical toilette and debridement, systemic antibiotics, and in some cases antibiotic-loaded cement. We present a retrospective review of patients with infected non-unions and segmental bone defects treated with antibiotic-loaded cement spacers. Methods: We retrospectively reviewed thirteen cases of long bone infected non-unions and four cases of segmental bone defects. Antibiotic-loaded cement was used in all cases. The surgical technique consisted in covering the osteosynthesis with antibiotic-loaded cement in non-unions; in segmental bone defects; the cement was molded according to the defect size. Results: Minimum follow up was one year. In four cases the spacer was not removed, and served as the definitive treatment. In the remaining 13 cases, the material was removed, and a second surgery was performed for final osteosynthesis and bone reconstruction. In all cases autogenic bone graft with antibiotic was used. Fifteen patients (88.2%) healed uneventfully without recurrence of infection. One patient received a below knee amputation, and one is under treatment, both for recurrent infection. Conclusions: Antibiotic-loaded cement allows to locally control infections, fills dead space and forms a pseudo synovial membrane which favors osteointegration. In some infected non-unions it serves as definitive treatment.

Keywords : Polymethylmethacrylate; Infected non-unions; Segmental bone defect.

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