Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis

Ahmed H Elhessy; Jessica C Rivera; Henry T Shu; Taj-Jamal Andrews; John E Herzenberg; Janet D Conway

doi:10.5005/jp-journals-10080-1554

Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis

Strategies Trauma Limb Reconstr. 2022 May-Aug;17(2):123-130. doi: 10.5005/jp-journals-10080-1554.

Authors

Ahmed H Elhessy¹, Jessica C Rivera², Henry T Shu³, Taj-Jamal Andrews⁴, John E Herzenberg¹, Janet D Conway¹

Affiliations

¹ International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America.
² International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America; Louisiana State University Health Science Center, New Orleans, Louisiana, United States of America.
³ Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America.
⁴ Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States of America.

Abstract

Aim: In this study, we present a detailed surgical technique for treating chronic osteomyelitis (COM) of the intramedullary canal with injectable tobramycin and vancomycin-loaded calcium sulfate (CS).

Background: Chronic osteomyelitis of the long bones has been treated using antibiotic-impregnated polymethyl methacrylate (PMMA), which typically requires a second procedure for removal.

Technique: Removal of the infected intramedullary nail (if any), copious irrigation, canal reaming, and intramedullary canal injection of vancomycin- and tobramycin-loaded calcium sulfate as a single-stage procedure for the treatment of COM of long bones.

Conclusion: Intramedullary injection of vancomycin- and tobramycin-loaded CS can be used as a single-stage procedure for the treatment of long bone intramedullary COM. Further studies are necessary to compare the long-term outcomes of antibiotic-coated CS vs other antibiotic carriers for infection eradication.

Clinical significance: The authors have endeavored to explain the best surgical technique to eradicate long bones COM with injectable tobramycin and vancomycin-loaded CS.

How to cite this article: Elhessy AH, Rivera JC, Shu HT, et al. Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis. Strategies Trauma Limb Reconstr 2022;17(2):123-130.

Keywords: Antibiotic-loaded calcium sulfate; Bone infection; Chronic osteomyelitis; Local antibiotic delivery; Long bone infection; Retrospective review.