Resumen de Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Rodrigo Brandariz, Javier Bennice, Jorge G. Boretto, Ezequiel Ernesto Zaidenberg, Pablo De Carli, Gerardo Luis Gallucci

• español

  Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH).Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses.Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos <2 cm (7 pacientes) y grupo con defectos ≥2 cm (4 pacientes). No se observaron diferencias significativas entre la mediana de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el de otros gérmenes (48 días [RIC 45-75] vs. 73,5 días [RIC 56-149], p = 0,2002 Mann-Whitney), ni en la proporción del tamaño del defecto óseo según el desarrollo de SARM o de otro germen (60% vs. 17%, p = 0,242 Fisher). Todos los cultivos fueron negativos y se logró la consolidación del foco fracturario, sin recurrencia de la infección.Conclusiones: El CERA es una buena opción terapéutica en el primer tiempo quirúrgico para un paciente con SIH. Se pudo controlar la infección, lo que permitió la reconstrucción secundaria de la seudoartrosis. AbstractObjetive: To evaluate the efficiency of the antibiotic cement rod (ACR) in the eradication of infection in infected humerusnonunion (IHN).Material and methods: We included 11 patients with IHN with a mean age of 48 years. The time between fracture-surgery was 25 months. The ACR was impregnated with vancomycin in 9 of de 11 cases. Follow-up was 54 months.Results: Methicillinresistant staphylococcus aureus (MRSA) was isolated in 5 of cases. All patients received antibiotics systemically for 7 weeks. Vancomycin was the most commonly used antibiotic. Time between ACR and reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual space of the nonunion was measured with dichotomous variables and classified into two groups: group 1, < 2 cm (7 patients) and group 2, ≥2 cm (4 patients).  No significant differences were observed between the number of days in which the ACR was placed and the development of the SAMR as compared to other germs [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p= 0.2002 Mann Whitney]. Nor were differences observed in the size of the defect in those who developed MRS or any other germ (p=0.242 Fisher). Reconstruction was performed with different techniques. Laboratory parameters were normal, cultures were negative. Fractures could be consolidated without infection recurrence.Conclusions: ACR is a good treatment option for a patient with an INH. The infection could be controlled in all of the cases, which allowed the secondary reconstruction of the nonunion

• English

  Objetive: To evaluate the efficiency of the antibiotic cement rod (ACR) in the eradication of infection in infected humerusnonunion (IHN).Material and methods: We included 11 patients with IHN with a mean age of 48 years. The time between fracture-surgery was 25 months. The ACR was impregnated with vancomycin in 9 of de 11 cases. Follow-up was 54 months.Results: Methicillinresistant staphylococcus aureus (MRSA) was isolated in 5 of cases. All patients received antibiotics systemically for 7 weeks. Vancomycin was the most commonly used antibiotic. Time between ACR and reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual space of the nonunion was measured with dichotomous variables and classified into two groups: group 1, < 2 cm (7 patients) and group 2, ≥2 cm (4 patients).  No significant differences were observed between the number of days in which the ACR was placed and the development of the SAMR as compared to other germs [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p= 0.2002 Mann Whitney]. Nor were differences observed in the size of the defect in those who developed MRS or any other germ (p=0.242 Fisher). Reconstruction was performed with different techniques. Laboratory parameters were normal, cultures were negative. Fractures could be consolidated without infection recurrence.Conclusions: ACR is a good treatment option for a patient with an INH. The infection could be controlled in all of the cases, which allowed the secondary reconstruction of the nonunion