Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case se
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REVIEW
Treatment of fracture‑related infection of the lower extremity with antibiotic‑eluting ceramic bone substitutes: case series of 35 patients and literature review Sebastian Pesch1 · Marc Hanschen1 · Frederik Greve1 · Michael Zyskowski1 · Fritz Seidl1 · Chlodwig Kirchhoff1 · Peter Biberthaler1 · Stefan Huber‑Wagner1 Received: 13 January 2020 / Accepted: 26 March 2020 © The Author(s) 2020
Abstract Introduction The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. Method Literature review of treatments for FRI and description of own cases. Results We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. Conclusion The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection. Keywords Fracture-related infection · Ceramic bone substitute · Antibiotic-eluting ceramic bone substitute · Bone infection · Cerament™ G
Introduction Despite innovative treatment protocols developed during the last decades, posttraumatic fracture-related infection (FRI) is still associated with tremendous patient-related and socioeconomic issues in the clinical setting [1–5]. Recently, Metsemakers and coworkers have coined the term ‘fracture-related infection’ (FRI) and introduced a Sebastian Pesch and Marc Hanschen equally contributing authors. * Sebastian Pesch [email protected] 1
Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
consensus definition of posttraumatic bone infection. They defined several symptoms as confirmatory criteria of FRI (e.g., fistula, purulent drainage, positive culture of at least two separate deep samples) and stated other symptoms as suggestive criteria (e.g., clinical signs, radiological signs, single
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