Basten Batenburg, M. van (Michiel) (2016) Low-dose antibiotic cement rods in the treatment of posttraumatic osteomyelitis of the tibia:an analysis of eighteen consecutive cases. thesis, Medicine.
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Abstract
Introduction: High recurrence rates and poor antibiotic bone penetration make that posttraumatic osteomyelitis of the tibia remains a challenge for every trauma surgeon. General principles of implant removal, reaming of the canal, debridement of affected tissues, and administration of local and systemic antibiotics are widely accepted. However, consensus on the best local antibiotic therapy has not yet been reached. In recent years several new forms of local antibiotic therapy have been described. One of these is the antibiotic cement rod. The hypothesis was that after proper debridement, low-dose antibiotic cement rods in combination with systemic antibiotics are effective in treating active osteomyelitis of the tibia. Patients and methods: Data was collected retrospectively from all patients who were treated with an antibiotic cement rod at the University Medical Centre Utrecht between 2009 and 2015. Patients with a follow-up below 12 months were excluded. All patients were treated using low-dose antibiotic cement rods, handmade in the operating room, combined with systemic antibiotic therapy. After two weeks the cement rods were either removed or replaced depending on intraoperative culture results. The most important outcomes of this retrospective study were: recurrence of infection, infection control, and union. Results: Eighteen consecutive patients (14 male, 4 female) with a mean age of 44 years (range 16-72) were included. At a mean follow-up of 34 months (range 12-73), 33 cement rods were placed in 22 admissions (mean 1.8 per patient). The mean time of cement rod treatment was 40 days. Four patients (22%) showed recurrence of infection. After further treatment, infection control was achieved in all patients. Sixteen out of eighteen patients achieved a united fracture at last follow-up. Of the cultures taken upon rod removal 22% was positive. Conclusion: This study indicates that the use of low-dose antibiotic cement rods is effective in procuring infection control and union in the treatment of posttraumatic osteomyelitis of the tibia. With regard to the recurrence rate, the use of a low-dose antibiotic cement rod seems less effective than previously reported cement rod studies using high-dose antibiotic cement rods.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and IJpma, dr. F.F.A. |
| Supervisor name: | Plaatselijk begeleider: and Blokhuis, dr. T.J. and Instelling: Universitair Medisch Centrum Utrecht and Afdeling: Traumachirurgie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1691 |
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