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Antibiotic Bone Cement in the Treatment of Osteomyelitis: a Case Series of 3 Patients
Scott Licata; Tufts University; David Ruchlesman, MD; Newton-Wellesley Hospital
Newton-Wellesley Hospital, Newton, MA, USA

Introduction: The role of antibiotic-impregnated bone cement in the treatment of osteomyelitis continues to expand. Our experience with antibiotic-impregnated bone cement in the hand is reported. Three patients with metadiaphyseal and subchondral osteomyelitis and periarticular soft tissue infection are reviewed.

Materials and Methods: Three patients (1F, 2M), mean age 70.3 years (range, 27- 98 years) underwent urgent I&D of digital periarticular soft tissue infection and osteomyelitis. Sites included long finger metacarpal, index proximal phalanx, and thumb distal phalanx/IP joint. Etiologies included fight bite, digital soft tissue loss secondary to trauma, and ruptured mucous cyst. In each case, tobramycin and vancomycin-impregnated bone cement was used to pack the meduallary canal, reconstruct osseous deficiency, provide subchondral support and provide local high-concentration of broad-spectrum antibiotic.

Results: At mean follow up of 3 months (range 2 – 4 months), all three patients were pain free. Near-full functional digital range of motion was achieved in all patients. The cement packing of all three remained in stable position. At last follow up, there was no evidence of recrudescence of superficial or deep infection. No secondary surgeries were required.

Conclusions: Antibiotic-impregnated bone cement in the treatment of hand and digital osteomyelitis is an effective adjunct to intravenous antibiotics. Removal of the cement is not performed unless secondary reconstruction is needed. Advantages of this technique include local high concentration elutent effect of antibiotic, elimination of dead-space, and subchondral support.

Keywords: osteomyeleitis, antibiotic, bone cement, polymethyl methacrylate

Patient 1

Patient 2

Patient 3

Age

27

86

98

Sex

Male

Male

Female

Hand Involved

Right

Right

Right

Site

Long Finger Metacarpal

Thumb Proximal & Distal Phalanx

Index Finger Proximal Phalanx

Etiology

Fight Bite

Ruptured Mucus Cyst

Fall

Microbiology

Fusobacterium

Peptostreptococcus

Prevotella

Actinomyces Odontolyticus

S. Epidermidis

Candida Parapilosis

MRSA

S. Mutans

Prevotella

α-Hemolytic Strep

Post Operative ROM

Full Composite Flexion

Pad-DPC 0 mm

IP Joint 0/30

MCP: /75

PIP: /105

DIP: /65


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