Local Antibiotic Therapy in the Treatment of Open Fractures and Osteomyelitis

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Abstract
Local antibiotic therapy is part of the treatment protocol of open fractures and osteomyelitis. However, there are limitations in the literature evaluating the efficacy of the technique and controversies remain. Polymethylmethacrylate cement commonly is used as a delivery vehicle, but bioabsorbable vehicles are being investigated. The vehicle is impregnated with antibiotic(s) active against the suspected pathogens, usually an aminoglycoside and/or vancomycin. Elution depends on the surface area, the characteristics and permeability of the delivery vehicle, type and concentration of the antibiotic(s) used, presence of fluid, rate of fluid turnover, and time postimplantation. Local antibiotic therapy is a safe technique resulting in high local concentration of antibiotics with minimal systemic levels. Local antibiotics effectively have controlled infection in animal models and, despite limitations of the existing literature, seem to be useful in the clinical setting. The length of implantation and the need for removal of the delivery vehicle remain controversial. Nonabsorbable vehicles may eliminate the need for reoperation and removal.