- Discussion:
- discussion of addition of antibiotics to cement and osteomyelitis / vancomycin in ca sulfate
- after fracture stabilization has been completed, osseous defects may be filled w/ antibiotic-PMMA beads;
- these beads provide local depot administration of antibiotic and maintain space for subsequent bone graft;
- as noted by Keating, et al (1996), bead pouches help reduce the infection rate in open tibia fractures from 16% to 4%;
- Reamed nailing of open tibial fractures: does the antibiotic bead pouch reduce the deep infection rate?
- other considerations:
- wound vac
- structural support:
- reference: Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects.
- considerations for individual antibiotics:
- vancomycin properties in cement:
- typically add 4 gm of Vancomycin per batch of cement;
- gentamicin and tobramycin properties in cement
- add 2.4 gm of tobramycin per cement package, and fashion small beads attached to a O silk suture;
- references:
- The use of tobramycin-impregnated polymethylmethacrylate beads in the therapy of deep bone and joint infections.
- The treatment of infected nonunions with gentamicin-polymethylmethacrylate antibiotic beads.
- Gentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis..
- technique considerations:
- once cement no longer sticks to fingers, roll cement into small spheres and thread over 18 gauge wire or #2 Ethibond;
- counting the beads and adding methylene blue helps ensure that none of the beads will be left behind at removal
- references:
- Antibiotic bead chains.
- The antibiotic bead pouch technique. The management of severe compound fractures.
- Long-term implantation of gentamicin-polymethylmethacrylate antibiotic beads.
- Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis.
- In vitro characteristics of tobramycin PMMA beads: compressive strength and leaching.
- Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis.
- The role of local antibiotic therapy in the management of compound fractures.
- Comparison of Vacuum-assisted Closure to the Antibiotic Bead Pouch for the Treatment of Blast Injury of the Extremity
- Commentary: Comparison of Vacuum-assisted Closure to the Antibiotic Bead Pouch for the Treatment of Blast Injury of the Extremity
- Antibiotic-leaching from polymethylmethacrylate beads.