Use of Vancomycin-Impregnated Calcium Sulfate in the Treatment of Osteomyelitis of the Jaw

Application of calcium sulfate as graft material in implantology and maxillofacial procedures: A review of literature

Calcium sulphate (plaster of Paris) has been used since 1892 to fill bone defects and as a good bone graft substitute. Calcium sulphate is an osteoconductive, inorganic substance. Following 75 years, many other authors reported variable and a better result in grafting of bone defects and in several cases of immediate and delayed dental implants for good osseointegrations, with no complications attributed to the calcium sulphate. Early results were variable, because of its conflicting crystalline structure, purity, and quality of the calcium sulphate. Apart from this, calcium sulphate also shows predictable resorption rate in vivo, presence of minimal trace elements and extremely uniform crystalline structure. Calcium sulphate is a bio-inert material and get resorbed over a period of weeks and fibrovascular tissue takes its place which eventually allows neovascularization and bone formation within the area. Use During the conventional surgical treatment addition of calcium sulphate as a bone graft of in case of placement of dental implants and pathological bony defects it improves the clinical outcome. Calcium sulphate also act as a barrier and filling material for the treatment of "through and through" bony lesions. Use of calcium sulphate as a bone graft substitute avoids the complications and morbidity associated with autograft like infection, second surgery.

Surgical debridement and continuous irrigation for early surgical site infection caused by Staphylococcus aureus with a closed patella fracture surgery: A case report

INTRODUCTION

Management of postoperative surgical site infection (SSI) is a huge challenge to orthopedic surgeons, and significantly impacts patients and their families due to long treatment cycles and associated discomfort experiences.

PRESENTATION OF CASE

A 68-year-old woman without a medical history of any comorbidities, diabetes, hypertension, allergies, or tuberculosis, was admitted to our hospital complaining of right knee pain following a fall. X-ray and CT scans revealed a closed right patella fracture. The patient underwent open reduction and internal fixation with tension band wiring and circle wire. Preoperative assessment showed normal nutritional status. Prophylactic cefazolin sodium pentahydrate was administered 30 min preoperatively and maintained for 24 h post-operation to prevent infection. The patient was discharged 3 days after the operation. However, the wound exhibited signs of infection: redness, swelling, and the presence of secretions. Outpatient dressings and oral antibiotics were prescribed but failed to control the infection, leading to rehospitalization. Surgical debridement and continuous articular irrigation were implemented to address the infection. Secretion cultures were taken to identify the causative bacteria. Levofloxacin and Rifampicin were used according to drug sensitivity tests. However, the patient experienced severe knee swelling and an iodine irritative reaction subsequently. Anti-allergic treatment and normal saline dressings were applied to alleviate swelling, pain, and skin irritation. MRI results indicated arthroedema and possible infection necessitating further surgical debridement, the patient rejected additional surgery and requested discharge. Levofloxacin and Rifampicin were used for a month to control the infection after discharge, accompanied by regular rehabilitation exercises. Fortunately, the infection was successfully managed, and knee function was satisfactorily restored.

DISCUSSION

SSI after patella fracture surgery can lead to a worse quality of life, serious economic burden, and psychological distress. Therefore, effective treatment methods for managing postoperative SSIs are very important.

CONCLUSION

Sufficient surgical debridement is vital to remove infection tissue of early SSI caused by Staphylococcus aureus with a closed patella fracture surgery. Continuous articular irrigation and sensitive antibiotics help control infection, and active rehabilitation training improves knee function recovery.

Outcome Analysis of the Use of Cerament® in Patients with Chronic Osteomyelitis and Corticomedullary Defects

Background: Chronic osteomyelitis (OM) is a progressive but mostly low-grade infection of the bones. The management of this disease is highly challenging for physicians. Despite systematic treatment approaches, recurrence rates are high. Further, functional and patient-reported outcome data are lacking, especially after osseous defects are filled with bioresorbable antibiotic carriers. Objective: To assess functional and patient-reported outcome measures (PROM) following the administration of Cerament^® G or V due to corticomedullary defects in chronic OM. Methods: We conducted a retrospective study from 2015 to 2020, including all patients who received Cerament^® for the aforementioned reason. Patients were diagnosed and treated in accordance with globally valid recommendations, and corticomedullary defects were filled with Cerament^® G or V, depending on the expected germ spectrum. Patients were systematically followed up, and outcome measures were collected during outpatient clinic visits. Results: Twenty patients with Cierny and Mader type III OM were included in this study and followed up for 20.2 ± 17.2 months (95%CI 12.1–28.3). Ten of these patients needed at least one revision (2.0 ± 1.3 revisions per patient (95%CI 1.1–2.9) during the study period due to OM persistence or local wound complications. There were no statistically significant differences in functional scores or PROMs between groups. Conclusion: The use of Cerament^® G and V in chronic OM patients with corticomedullary defects appears to have good functional outcomes and satisfactory PROMs. However, the observed rate of local wound complications and the OM persistence rate may be higher when compared to previously published data.

Antibiotic-loaded calcium sulfate in clinical treatment of chronic osteomyelitis: a systematic review and meta-analysis

Background

Present work was aimed to gather accessible evidence on the eradication rates and related postoperative complications of antibiotic-loaded calcium sulfate (CS) as an implant in the treatment of chronic osteomyelitis (COM).

Methods

Databases including PubMed, EMBASE, Medline, Ovid and Cochrane library were searched from their dates of initiation until November 2021. Two independent authors scrutinized the relevant studies based on the effectiveness of radical debridement combined with antibiotic-loaded CS for COM; data extraction and quality assessment of the Methodological Index for Non-Randomized Studies (MINORS) criteria were also performed by the authors. In addition, clinical efficacy mainly depended on the evaluation of eradication rates and complications, and all the extracted data are pooled and analyzed by STATA 16.0.

Results

A total of 16 studies with 917 patients (920 locations) were recruited, with an overall eradication rate of 92%. Moreover, the overall reoperation rate, overall refracture rate, overall delayed wound healing rate, and the rate of aseptic wound leakage were 9.0%, 2.0%, 20.0%, and 12.0%, respectively. Moreover, the choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate, and the incidence of postoperative complications in COM patients (all $$P>0.05$$ P > 0.05 ). The general quality of the included studies was fair.

Conclusions

Our meta-analysis indicated that the overall eradication rate of COM treated with antibiotic-loaded CS was 92%. Delayed healing is the most common postoperative complication. The choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate and the incidence of postoperative complications in COM patients.

Digitally designed, personalized bone cement spacer for staged TMJ and mandibular reconstruction - Introduction of a new technique

The aim of this paper is to introduce an innovative workflow for staged reconstruction of the mandible, including the temporomandibular joint (TMJ), using a temporary, patient-specific spacer. In cases of partial mandibular resection including disarticulation, sometimes needed to treat inflammatory bone disease, the spacer is intended to retain symmetry of the hard tissues, to preserve the soft tissues, and to act as a bactericidal agent. When complete healing of the affected surrounding tissues has occurred, final reconstruction using a patient-matched total TMJ endoprosthesis, in combination with an autogenous free bone flap, can be performed as a second-stage procedure. The crucial steps of the workflow are virtual surgical planning, manufacturing of a two-part silicone mold, and chairside manufacturing of the spacer using an established bone cement with gentamycin. The method was first introduced in two patients suffering from therapy-resistant chronic osteomyelitis. The presented protocol of staged surgery allows a much safer and predictable reconstruction compared with immediate reconstruction. The workflow also minimizes the potential risk of endoprosthesis infection - one of the major risks of implant failure.

Dual role of tannic acid and pyrogallol incorporated in plaster of Paris: Morphology modification and release for antimicrobial properties

The design of bioactive plasters is of major interest for the amelioration of dental and bone cements. In this article, a one pot and environmentally friendly strategy based on the addition of a cheap polyphenol-tannic acid (TA) or the main phenolic constituent of TA, namely pyrogallol (PY)- able to interact with calcium sulfate is proposed. Tannic acid and pyrogallol not only modify the morphology of the obtained plaster+TA/PY composites but a part of it is released and provides strong-up to twenty fold- antibacterial effect against Staphylococcus aureus. It is shown that the higher antibacterial efficiency of PY is related to a greater release compared to TA even if in solution the antibacterial effect of PY is lower than that of TA when reported on the basis of the molar concentration in PY units.

Case report of osteomyelitis of the mandible in osteopetrosis and management considerations

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Management guidelines in mandibular osteomyelitis in Osteopetrosis.

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A female patient with osteopetrosis presented osteomyelitis after teeth extraction.

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Our case suggests the importance to maintain at maximum existing mandibular bone.

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Dental prevention could reduce occurrence of osteomyelitis in Osteopetrosis.

Introduction and importance

Osteopetrosis is a poorly known and probably underdiagnosed pathology. It is caused by various genetic abnormalities resulting in osteoclast dysfunction. Functional and aesthetic consequences have a major impact on the patient’s quality of life. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. Management of this complication remains complex and often unsatisfactory.

Case presentation

We report a case of a 62-year-old woman with osteopetrosis, complicated by mandibular osteomyelitis with intra-oral bone exposure and submental fistulas. Management was performed with antibiotic therapy and surgical necrotic resection. This cured the fistulas but the bone exposure persisted.

Discussion

This case report highlights the difficulty of achieving complete healing of osteomyelitis in osteopetrosis. Antibiotic therapy, surgical management, or even hyperbaric oxygen therapy are required, but must be adapted to the case. A free flap procedure is undesirable but, when it is necessary, a bone marrow transplant could be considered to restore osteoclast function.

Conclusion

The management of mandibular osteomyelitis in patients with osteopetrosis must adapt to the situation and severity. To avoid most cases of osteomyelitic complications in patients suffering from osteopetrosis, we propose that a preventive strategy of better dental care should be considered.

Treatment of posttraumatic patella osteomyelitis with MRSA infection and knee stiffness: a case report

BACKGROUND

Posttraumatic patella osteomyelitis is rare, and the treatment of osteomyelitis remains to be challenging. Control of the infection commonly costs a long time, and it is easily to cause knee stiffness. In addition, there is no unified protocol for the treatment of knee stiffness.

CASE PRESENTATION

We reported a case of posttraumatic patella osteomyelitis that successive infected with methicillin-resistant staphylococcus aureus (MRSA) after multiple surgeries. We successfully treated osteomyelitis by one-staged surgery, but the patient present knee stiffness after treatment. Thus Ilizarov external fixation system was further used to gradually adjust the mobility by exerting mechanical stress to the joint. After adjusting the frame under a scheduled plan, the patient successfully restored satisfactory knee function.

CONCLUSIONS

Adequate debridement is the key to control infections of posttraumatic osteomyelitis. Control the infection of posttraumatic patella osteomyelitis by one-staged surgery is achievable and could shorten the knee immobilization period. When knee stiffness occurs, scheduled range of motion (ROM) adjustment using Ilizarov frame with hinges might be a safe and useful method to restore function.

Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient

Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.