Abstract
Purpose
The optimal means of local antibiotic delivery for fracture related infection is unknown. Until now, intramedullary application of calcium sulphate based local antibiotics has been challenging. We report on the use of a newly available mode of preparation and delivery: the Stimulan Bullet Mat and Introducer (Biocomposites Ltd, Staffordshire, England).
Methods
A retrospective analysis of prospectively collected data for infection cases at two separate tertiary referral institutions was performed. We included cases of long bone FRI with a retained intramedullary nail, treated with a single stage protocol of metalwork removal, debridement, local antibiotic application using the novel mould and applicator, with additional bony stabilisation and soft tissue reconstruction where required.
Results
All 13 patients achieved infection remission rate with an average follow-up of 19.7 months (range 12–28). All 6 patients with infection around an unhealed fracture achieved union at an average 8 months (range 4–12) from debridement. No patients developed aseptic wound leak.
Conclusions
Antibiotic impregnated calcium sulphate can be used safely as part of a single stage treatment protocol for the treatment of long bone fracture related infection following intramedullary nailing. We have demonstrated high rates of infection remission and union, using a newly available intramedullary applicator.
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All authors contributed to the study conception, design and material preparation. Operations were performed by the senior authors AI, AV, NH and AT. Data collection, analysis and first draft were done by PP. All authors commented on previous versions of the manuscript and have read and approved the final manuscript.
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Patel, P., Iliadis, AD., Vris, A. et al. Intramedullary application of local antibiotic bullets for the treatment of long bone fracture related infection. Eur J Orthop Surg Traumatol 33, 385–391 (2023). https://doi.org/10.1007/s00590-022-03205-2
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DOI: https://doi.org/10.1007/s00590-022-03205-2