Journal of Musculoskeletal Trauma

Two-Stage Reconstruction of Infected Nonunion of Long Bones using Antibiotics-Impregnated Cement Beads: Se Hyun Cho, Soon Taek Jeong, Hyung Bin Park, Sun Chul Hwang, Yong Chan Ha, In Hwan Hwang; J Korean Fract Soc 2004;17(4):395-400. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.395

PURPOSE
To evaluate treatment results between internal and external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads.
MATERIALS AND METHODS
In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion site was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group I versus external fixation in group II. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks).
RESULTS
The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group I. Infection recurred in two of 28 cases in group II, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group I and group II. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group I was similar to group II in bony and functional result (p>0.05).
CONCLUSION
Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.

Citations

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Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef

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Two-Stage Treatment of Infected Nonunion of the Tibia using Antibiotics Impregnated Cement Beads and External Fixator: Yeon Cheon Jeong; J Korean Soc Fract 2000;13(4):884-890. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.884

Abstract PDF: PURPOSE
To evaluate the results of two-stage treatment for infected nonunion of the tibia using antibiotics impregnated cement beads(AICB) and external skeletal fixation.
MATERIALS AND METHODS
We analyzed 25 infected tibial nonuinon that were treated with AICB and external skeletal fixation from July 1995 to April 1998. The average follow-up was 25 months. In the first stage, sequestrectomy and radical debridement was performed. and then the soft tissue and bony defects were filled with AICB and was stabilized with external skeletal fixation. In the second stage, after removal of AICB and the nonunion site was either grafted with autogenous cancellous bone graft(17 patients) or internal bone transport(8 patients) was performed according to the bone defect size.
RESULTS
The average bony union time was 36.8 weeks. The intervening time between the first and second stages of treatment was 4 to 6 weeks (average 5.4 weeks). There were 8 pin tract infections, 1 Postoperative infection after the second-stage bone grafting. According to Paley's functional assessment system, excellent or good results were obtained in 20 cases. There was no poor result.
CONCLUSION
In our opinion, the above advocated two-stage treatment is an acceptable treatment modality for the management of infected tibial nonunion.

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Infected non-union of the Tibia: Kwon Ik Ha, Seung Ho Kim, Kyoung Ho Yoon, Sang Ho Moon; J Korean Soc Fract 1997;10(4):812-815. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.812

Abstract PDF: There are two major problems in the management of infected non-union of the tibia: how to treat the infection; and how to obtain bony union. The previous treatment as debridement and antibiotic therapy often failed. Multiple hospitalization, many operative procedures, and prolonged treatments with parenteral antibiotics cause not only functional disability but also economic hardship and loss of self-esteem. The authors reviewed a case of infected non-union of the tibia who has received 12 operations and prolonged intravenous antibiotic therapy. It is suggested that if appropriate drainage, complete excision of necrotic tissues and rigid fixation is provided, prolonged intravenous antibiotic therapy seems to be unnecessary.

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Clinical Evaluation of Antibiotics Prophylaxis Against Infection in Clean Orthopaedic Surgery: Nam Hyun Kim, Soo Bong Hahn, Hong Jun Park; J Korean Soc Fract 1995;8(4):815-822. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.815

Abstract PDF: Prophylactic antibiotic treatment to prevent postoperative wound infection is an appealing routine to the orthopaedic surgeon. But, there has been no adequate guideline of prophylactic antibiotics in the field of ctean orthopaedic surgery. The purpose of this study was to investigate the method of effective administration of antibiotics and the factors affecting the postoperative infection in clean orthopaedic surgery. Two hundred and forty one patients were included in a prospective randomized double-blind trial comparing the efficacy of three days(group 1,42 patients) versus that of five days cefotiam(group II, 199 patients) injection for prophylaxis against wound infection in patients who had an operation using bone plate, Ender of Kiintscher nails, or other internal fixation devides. The two groups were similar in terms of mean age, sex ratio, duration of preoperative hospital stay, underlying risk factors and type of surgical procedure. A wound infection developed in one of the forty-two patients in group I(2.3%) and in nine of 199 patients in group II(4.5%). This difference of infection rate is not stati stically significant(p>O.05). Staphylococcus aureus, Staphylococcus epidermidis , Klebsiella pneumoniae and Enterobacter aerogenes were the common infecting organisms. And the infection rate in lower extremity operations was higher than that of other regions in the group II (p In conclusion. the recommended method of administration of prophylactic antibiotics in clean orthopaedic surgery to prevent postoperative wound infection is a high dosage injection of antibiotics one hour before surgery, intraoperative infusion of one dosage when the operation lasts more than one hour and then postoperatively within 72 hours. This will reduce the adverse effects of medication and will also reduce the costs.

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