The Results of Synthetic Pure Calcium Sulfate Impregnated with Antibiotic in the Management of Bone Infections and Non-unions
Volume 7 | Issue 2 | May – Aug 2019 | Page: 22-26 | Keith B. Tamboowalla, Jaison Thomas, Madan Mohan M, Anoop Pilar, Belliappa C P, Rajkumar S Amaravathi
Authors: Keith B. Tamboowalla , Jaison Thomas , Madan Mohan M , Anoop Pilar , Belliappa C P , Rajkumar S Amaravathi .
 Department of Orthopaedics, St Johns Medical College Hospital, Bengaluru, Karnataka.
Address of Correspondence
Dr. Dr. Rajkumar S Amaravathi,
Professor and Unit Head,
Department of Orthopaedics, St Johns Medical College Hospital, Bengaluru, Karnataka.
Background: The problems in treating bone infections and non-unions of the bone continue to plague orthopedic practice. The authors present a retrospective analysis with the purpose of evaluating the outcome of infections and non-unions treated with antibiotic-impregnatedcalcium sulfate (AICS).
Materials and Methods: We assessed the outcomes of 25 patients who were operated between May 2014 and May 2017 for osteomyelitis (9) and long bone non-union (16). Each patient underwent a standard surgical procedure as the situation demanded, along with instillation of AICS into the defect. The outcomes measured were the presence of infection and union.
Results: At 1-year follow-up, 8 (88.89%) of the osteomyelitis patients showed good radiographic healing and no recurrence, while one had a relapse of osteomyelitis. Fourteen (87.5%) of the non-union patients had successful union, while persistent non-union developed in twopatients. Twenty-three (92%) patients had returned to full independent activities of daily living, including 19 who had returned to unrestricted leisure activities and pre-operative employment status.
Conclusions: We report the results of the use of AICS in our series, which showed high union rates and eradication of infection. Our experience shows that the use of AICS offers numerous advantages and promises in treating these conditions, which merit further study.
Keywords: Osteomyelitis, infected non-union, calcium sulfate, bone graft substitute, Stimulan, Fracture healing
1. Borrelli J Jr.,Prickett WD, Ricci WM. Treatment of nonunions and osseous defects with bone graft and calcium sulfate. ClinOrthopRelat Res 2003;411:245-54.
2. Bondurant FJ, Cotler HB, Buckle R, Miller-Crotchett P, Browner BD. The medical and economic impact of severely injured lower extremities. J Trauma 1988;28:1270-3.
3. Simon JP, Hoogmartens M. The value of posterolateral bone-grafting for non-union of the tibia. ActaOrthopBelg 1984;50:557-64.
4. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989;3:192-5.
5. LeGeros RZ. Calcium phosphate-based osteoinductive materials. Chem Rev 2008;108:4742-53.
6. Barradas AM, Yuan H, van Blitterswijk CA, Habibovic P. Osteoinductive biomaterials: Current knowledge of properties, experimental models and biological mechanisms. Eur Cell Mater 2011;21:407-29.
7. Chotanaphuti T, Surijamorn P, Luenam S, Ongnamthip P. In vitroantimicrobial activity of phramongkutklao hydroxyapatite antibiotic pellet. J Med Assoc Thai 2008;91:1868-72.
8. Moore WR, Graves SE, Bain GI. Synthetic bone graft substitutes. ANZ J Surg 2001;71:354-61.
9. Drosos GI, Ververidis A, Babourda EC, Kakagia D, Verettas DA. Calcium sulfate cement in contained traumatic metaphyseal bone defects. SurgTechnolInt 2012;22:313-9.
10. McNally MA, Ferguson JY, Lau AC, Diefenbeck M, Scarborough M, Ramsden AJ, et al. Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: A prospective series of 100 cases. Bone Joint J 2016;98-B:1289-96.
11. Papagelopoulos PJ, Mavrogenis AF, Tsiodras S, Vlastou C, Giamarellou H, Soucacos PN, et al. Calcium sulphate delivery system with tobramycin for the treatment of chronic calcaneal osteomyelitis. J Int Med Res 2006;34:704-12.
12. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 2010;68:629-32.
13. Rand BC, Penn-Barwell JG, Wenke JC. Combined local and systemic antibiotic delivery improves eradication of wound contamination: An animal experimental model of contaminated fracture. Bone Joint J 2015;97-B:1423-7.
14. Kluin OS, van der Mei HC, Busscher HJ, Neut D. Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis. Expert Opin Drug Deliv 2013;10:341-51.
15. Ferguson JY, Dudareva M, Riley ND, Stubbs D, Atkins BL, McNally MA, et al. The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: A series of 195 cases. Bone Joint J 2014;96-B:829-36.
16. Kumar CY, Nalini KB, Menon J, Patro DK, Banerji BH. Calcium sulfate as bone graft substitute in the treatment of osseous bone defects, a prospective study. J ClinDiagn Res 2013;7:2926-8.
17. Drampalos E, Mohammad HR, Kosmidis C, Balal M, Wong J, Pillai A, et al. Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: The silo technique. Foot (Edinb) 2018;34:40-4.
18. Badie AA, Arafa MS. One-stage surgery for adult chronic osteomyelitis: Concomitant use of antibiotic-loaded calcium sulphate and bone marrow aspirate. IntOrthop 2019;43:1061-70.
19. Wiss DA, Stetson WB. Nonunion of the tibia treated with a reamed intramedullary nail. J Orthop Trauma 1994;8:189-94.
20. Ring D, Jupiter JB, Gan BS, Israeli R, Yaremchuk MJ. Infected nonunion of the tibia. ClinOrthopRelat Res 1999;???:302-11.
21. Bajada S, Harrison PE, Ashton BA, Cassar-Pullicino VN, Ashammakhi N, Richardson JB, et al. Successful treatment of refractory tibial nonunion using calcium sulphate and bone marrow stromal cell implantation. J Bone Joint Surg Br 2007;89:1382-6.
22. Masrouha KZ, Raad ME, Saghieh SS. A novel treatment approach to infected nonunion of long bones without systemic antibiotics. Strategies Trauma Limb Reconstr 2018;13:13-8.
|How to Cite this article: Tamboowalla K B, Thomas J, Madan Mohan M, Pilar A, Belliappa C P, Amaravathi R S. The Results of Synthetic Pure Calcium Sulfate Impregnated with Antibiotic in the Management of Bone Infections and Non-unions. Journal of Karnataka Orthopaedic Association. May-Aug 2019; 7(2): 22-26|
Leave a ReplyWant to join the discussion?
Feel free to contribute!