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New bone formation using antibiotic-loaded calcium sulfate beads in bone transports for the treatment of long-bone osteomyelitis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Bone transport is one of the most frequently used techniques for critical-sized bone defects due to trauma or infection. To fill the defect area and avoid the collapse of soft tissues during transport, some authors have described the use of polymethylmethacrylate or absorbable antibiotic carriers in the form of cylindrical blocks.

Methods

In this article, we present our experience in the treatment of post-traumatic osteomyelitis of the lower and upper limbs, using a bone transport technique with antibiotic-loaded calcium sulfate in the form of beads. Results

With the progressive absorption of calcium sulfate, we observed the formation of a bone-like tissue envelope at the periphery of the defect area. Histological analysis and direct visualization during open revision surgery of the docking site in all patients confirmed the presence of newly formed bone tissue with a high presence of osteoblasts and few osteoclasts; no areas of necrosis or signs of infection were observed. This bone envelope maintained the mechanical protective function of the transport path and docking site, and also provided a biological stimulus to avoid the development of necrotic areas and optimize the consolidation phase. Conclusion

Bone transport with calcium sulfate beads improves biological and mechanical support and reduces the number of surgeries required.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia (BS), Italy

    Marco Domenicucci, Claudio Galante, Franco Cavina Pratesi, Giuseppe Milano & Alessandro Casiraghi

  2. Department of Laboratory Diagnostics, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia (BS), Italy

    Melissa Anna Teresa Monica

  3. Department of Orthopedics and Traumatology, Sant’ Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli (VC), Italy

    Domenico Costantino Aloj

  4. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia (BS), Italy

    Giuseppe Milano

Authors
  1. Marco Domenicucci
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  2. Claudio Galante
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  3. Franco Cavina Pratesi
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  4. Melissa Anna Teresa Monica
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  5. Domenico Costantino Aloj
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  6. Giuseppe Milano
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  7. Alessandro Casiraghi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MD. The first draft of the manuscript was written by MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marco Domenicucci.

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The authors declare that they have no conflict of interest.

Ethical approval

This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Approval from the ethics committee was not required due to the characteristics of the study and the number of patients.

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Domenicucci, M., Galante, C., Cavina Pratesi, F. et al. New bone formation using antibiotic-loaded calcium sulfate beads in bone transports for the treatment of long-bone osteomyelitis. Eur J Orthop Surg Traumatol 33, 2489–2496 (2023). https://doi.org/10.1007/s00590-022-03461-2

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  • DOI: https://doi.org/10.1007/s00590-022-03461-2

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