alex at orto
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Apr 4, 2007, 3:52 AM
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Re: [ORT-L] infected nonunions
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Hello Rob,
Wednesday, April 4, 2007, 8:18:23 AM, you wrote:
RS> Please help me find info on the debridement/placement of abx PMMA in
RS> infected long bone defects followed by autogenous graft. Did Dr. Lindsay do
J Orthop Trauma. 2002 Nov-Dec;16(10):723-9.
Intramedullary infections treated with antibiotic cement rods: preliminary
results in nine cases.
Paley D, Herzenberg JE.
Rubin Institute for Advanced Orthpaedics, International Center for Limb
Lengthening, Baltimore, Maryland 21215, USA. dpaley@lifebridgehealth.org
The treatment of intramedullary infections after nailing usually includes
removal of the rod, debridement of the canal, and, in many cases, insertion of
antibiotic-impregnated cement beads. These beads offer no mechanical support and
are difficult to remove if left in place for more than 2 weeks. We present an
alternative for filling the medullary canal's noncollapsible dead space with an
antibiotic-impregnated cement rod. This rod can be custom-made at the time of
surgery, using different diameter chest tubes as molds and embedding a 3-mm
beaded guidewire within the cement. The smooth molded surface of this nail makes
extraction of the cement rod relatively easy. The cement rod also provides some
limited temporary support to the fracture or nonunion site while the infection
is being treated. After 6 weeks, the rod can be removed and replaced with a
definitive metal intramedullary nail, with or without bone grafting to treat the
previously infected fracture or nonunion site. We retrospectively reviewed nine
cases of intramedullary infection treated with antibiotic-impregnated molded
cement rods. These included six femora, two tibiae, and one humerus. The cause
of infection was lengthening or transport over nail in six cases,
fixator-augmented nailing of osteotomies in two, and fracture fixation in one.
The follow-up period after surgery ranged from 38 to 48 months. No recurrent
infection occurred during this follow-up period, and no patient required
antibiotics after the rod was removed. In all cases, the canal cultures were
negative after rod removal. The cement rod was removed between 29 and 753 days
after implantation. Fracture of the rod occurred in one case in which the rod
was left in place for more than 1 year. We conclude that this method is a
relatively simple and inexpensive alternative for the treatment of
intramedullary infections.
--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
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