Management of infected non-union in long bones: our experience with bone cement

• Published in: Journal of clinical orthopaedics and trauma Vol. 1; no. 1; pp. 41 - 46
• Main Authors: Agrawal, Mayank, Yuvarajan, P, Maini, Lalit, Gautam, VK
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2010
• Subjects: bone cement; Infected non union; bone cement; Infected non union
• ISSN: 0976-5662; 2213-3445
• DOI: 10.1016/S0976-5662(11)60009-X

Infected non-union in bones is one of the most challenging orthopedic complications to manage. There is a significant impact on the life of the patient; social, financial, physical, and mental with considerable associated morbidity. Persistent infection, shortening, bone loss, joint stiffness and disability complicate the non-union. High level of local antibiotic achieved with gentamicin PMMA cement is also been suggested to affect osteoblast regeneration thereby delaying the process of fracture healing.
The present study aims to evaluate the role of bone cement in various available forms to control the infection and achieve the bony union; and to identify the factors influencing the functional outcome in these cases.
This study included fourteen patients of infected non-union involving long bones. Thirteen of these were Cierny and Mader type III while remaining one was type IV. Following the diagnosis patients were treated with ‘infection-elimination first’ strategy. This strategy involved two steps: control of infection by local radical debridement of dead tissue followed by reconstruction using external or internal fixation as deemed necessary by the type of fracture and the bone involved. Gentamicin-PMMA is useful as an effective drug delivery system for local antibiotic therapy in bone and soft-tissue infections.
All 14 patients achieved bony union at fracture site. Control of infection was also achieved except for in one patient, who had a bony union with intermittent wound discharge. Overall, the outcome following treatment of infected non-union was good to excellent using ASAMI criteria. In our study, we found that bone results are in general, better compared to functional results. Radical debridement with removal of all sequestrated bone fragments is mandatory before implantation of gentamicin PMMA construct into the infected bone cavity.