Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 1993
Comparative StudyGentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis.
A model of chronic osteomyelitis was used to evaluate the efficacy of treatment with debridement alone; debridement plus gentamicin-polymethylmethacrylate (PMMA) bead implantation; debridement plus systemic antibiotic therapy; and debridement plus systemic antibiotics and bead implantation. Debridement with the implantation of gentamicin-PMMA beads and debridement followed by systemic antibiotics were significantly more successful forms of treatment for chronic osteomyelitis than debridement alone or debridement with the implantation of PMMA beads not impregnated with antibiotics. Debridement followed by the implantation of PMMA-gentamicin beads and the use of systemic antibiotics produced the greatest success rate. Treatment with a combination of gentamicin-PMMA beads and systemic antibiotics resulted in a 100% success rate, which, although not statistically better than either treatment alone, suggests a trend.
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Clin. Orthop. Relat. Res. · Oct 1993
The role of local antibiotic therapy in the management of compound fractures.
Seven hundred four compound fractures (198 [28%] Grade I, 259 [37%] Grade II, and 247 [35%] Grade III) were treated during a seven-year period at the author's institution. One hundred fifty-seven open fractures (22%) (Group A) received systemic antibiotic prophylaxis only, whereas 547 compound fractures (78%) (Group B) were treated with local application of antibiotic beads (tobramycin) in addition to prophylaxis. Fracture grades, age, gender, fracture location, and length of follow-up period were not significantly different between the two groups. ⋯ However, by subdivision into the fracture grades, only the IIIB types had a statistically significant decrease of infection in Group B versus Group A; the wound infection rate was 39% (9/23) in Group A and 7.3% (7/96) in Group B. The rate of chronic osteomyelitis was 26% (6/23) in Group A and 6.3% (6/96) in Group B. Prophylactic use of antibiotic-laden PMMA beads in addition to systemic antibiotics was of benefit in preventing infectious complications in compound fractures, in particular in Type IIIB open fractures.