Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis

JOURNAL TITLE: Strategies in Trauma and Limb Reconstruction

Author
1. Henry T Shu
2. Taj-Jamal Andrews
3. Ahmed H Elhessy
4. Jessica C Rivera
5. Janet D Conway
6. John E Herzenberg
ISSN
1828-8936
DOI
10.5005/jp-journals-10080-1554
Volume
17
Issue
2
Publishing Year
2022
Pages
8
Author Affiliations
    1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America
    1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America; Louisiana State University Health Science Center, New Orleans, Louisiana, United States of America
    1. Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America
    1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America
    1. Department of Orthopedic Surgery, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
    1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America
  • Article keywords
    Antibiotic-loaded calcium sulfate, Bone infection, Chronic osteomyelitis, Local antibiotic delivery, Long bone infection, Retrospective review

    Abstract

    Aim: In this study, we present a detailed surgical technique for treating chronic osteomyelitis (COM) of the intramedullary canal with injectable tobramycin and vancomycin-loaded calcium sulfate (CS). Background: Chronic osteomyelitis of the long bones has been treated using antibiotic-impregnated polymethyl methacrylate (PMMA), which typically requires a second procedure for removal. Technique: Removal of the infected intramedullary nail (if any), copious irrigation, canal reaming, and intramedullary canal injection of vancomycin- and tobramycin-loaded calcium sulfate as a single-stage procedure for the treatment of COM of long bones. Conclusion: Intramedullary injection of vancomycin- and tobramycin-loaded CS can be used as a single-stage procedure for the treatment of long bone intramedullary COM. Further studies are necessary to compare the long-term outcomes of antibiotic-coated CS vs other antibiotic carriers for infection eradication. Clinical significance: The authors have endeavored to explain the best surgical technique to eradicate long bones COM with injectable tobramycin and vancomycin-loaded CS.

    Supplementary files

    © 2019 Jaypee Brothers Medical Publishers (P) LTD.   |   All Rights Reserved