Journal
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
Volume 46, Issue 8, Pages 1447-1456Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.injury.2015.05.008
Keywords
Osteomyelitis; Open fractures; PMMA beads; Local antibiotics; Antibiotic-loaded cement; Antibiotic cement nails
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The use of local antibiotics for the prevention of infection in the setting of open fractures and as part of the treatment of osteomyelitis is well established. Antibiotics are most commonly incorporated into polymethylmethacrylate (PMMA) cement, which can then be formed into beads, moulded to fit a bone defect or used to coat a guide wire or IM nail. Newer delivery vehicles and techniques are being evaluated to improve upon these methods. Many factors influence how local antibiotics are applied. Treatment strategies are challenging to standardise due to the variability of clinical presentations. The presence of hardware, upper versus lower extremity, healed versus non-healed fracture and quality of soft tissues overlying the affected bone, as well as patients' comorbidities all need to be considered. Despite the accepted use of local antibiotic therapy in orthopaedic trauma, high-quality evidence regarding the use of local antibiotics is lacking. Indications, techniques, dosages, types of antibiotics, elution properties and pharmacokinetics are poorly defined in the clinical setting. The purpose of our manuscript is to review current strategies and provide practical tips for local application of antibiotics in orthopaedic trauma. We focus on delivery vehicles, types of antibiotics, dosage recommendations when mixed with PMMA and indications. (C) 2015 Elsevier Ltd. All rights reserved.
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