Empleo de osteosíntesis recubierta de cemento con antibiótico en el tratamiento de la osteomielitis. Presentación de dos casos

• Jorge Luis Soutullo ^[1] ; Santiago Argüelles ^[1] ; Martín Pablo Rodríguez ^[1] ; Enrique Pereira ^[1]
  1. [1] Instituto Argentino de Diagnóstico y Tratamiento

     Instituto Argentino de Diagnóstico y Tratamiento

     Argentina

     
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 85, Nº. 4, 2020, págs. 403-417
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2020.85.4.1004
• Títulos paralelos:
  • Osteomyelitis treatment with antibiotic cement-coated plate fixation. Two case reports
• Enlaces
  • Texto completo  1    2  
• Resumen
  • español

    El tratamiento de la osteomielitis asociada a la falla de la osteosíntesis representa un verdadero desafío para el cirujano ortopédico. El retiro del implante, la limpieza quirúrgica del área afectada y la fijación externa como métodos de estabilidad transitoria, sumados a la administración de antibióticos por vía sistémica son conductas habituales en el manejo inicial de la infección asociada a la falla del implante. No obstante, la suma de estas medidas puede no ser suficiente para controlar completamente el cuadro. El agregado local de cemento con antibiótico permite la liberación continua y sostenida del agente que alcanza una concentración local significativamente más alta que las concentraciones inhibitorias bacterianas mínimas necesarias, a expensas de una menor toxicidad sistémica. Se presentan dos casos de osteomielitis asociada a la falla de la osteosíntesis tratados mediante una nueva síntesis con placa revestida de cemento con antibiótico. Se logró controlar la infección y la consolidación ósea en ambos casos. El resultado funcional fue excelente con un puntaje QuickDASH de 6,3 y 4,5, respectivamente.

  • English

    Treatment of osteomyelitis associated with osteosynthesis failure represents a real challenge for the orthopedic surgeon. Implant removal, surgical debridement of the affected area, and external fixation as a temporary stabilization method coupled with antibio-tic therapy administered by the systemic route constitute the basis for the initial management of infections associated with implant failure. However, this combined management may prove inadequate to achieve complete control of the infection. The local use of antibiotic-loaded cement allows for maintaining a sustained agent release that reaches significantly higher concentrations than the minimum required bacterial inhibitory concentrations while reducing the associated systemic toxicity. We present two cases of osteomyelitis associated with osteosynthesis failure treated with a second osteosynthesis procedure with an antibiotic cement-coated plate. Infection control and bone union were achieved in both cases. The functional outcome was excellent with Quick-DASH scores of 6.3 and 4.5 points, respectively

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