Osseous union after antibiotic cement application with retention of stable orthopaedic hardware in fracture-related infections without union

Abstract

Objective:To evaluate treatment outcomes of patients treated with antibiotic impregnated cement applied over implanted orthopaedic hardware, in the setting of fracture-related infection, without osseous union, after open reduction internal fixation.Design:Retrospective observational case series.Setting:Level 1 trauma centerPatients/Participants:Retrospective review of 15 patients who underwent antibiotic cement application to their retained plate for the treatment of acute fracture-related infections (12) and acutely infected nonunion (3) status after open reduction internal fixation (ORIF).Outcomes:Suppression of infection and radiographic union by final follow-up.Results:Antibiotic plate application successfully led to fracture union in all 15 patients (100%). Three of these patients (20%) required removal of hardware. Of these 3 patients, all 3 achieved fracture union before hardware removal. However, 2 of these patients developed a chronic infection and were placed on long term PO antibiotics for chronic infection suppression, thus making them ineligible for classification as free of infection.Conclusions:The results of this study suggest that application of antibiotic cement to retained plates/screws for ORIF during treatment of both acute fracture infections and acutely infected nonunions is a viable technique to achieve osseous union. Hardware removal may be required in some cases. Use of this technique supports fracture healing and local infection control, while maintaining construct stability long enough to achieve fracture union.