The Journal of Bone and Joint Surgery (American). 2005;87:107-112.
doi:10.2106/JBJS.C.01670
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Effectiveness of Local Antibiotic Delivery with an Osteoinductive and Osteoconductive Bone-Graft Substitute

Anthony A. Beardmore, MD1, Daniel E. Brooks, BS2, Joseph C. Wenke, PhD2 and Darryl B. Thomas, MD2

1 Orthopaedic Service, Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996. E-mail address for A.A. Beardmore: anthony.beardmore{at}cen.amedd.army.mil
2 United States Army Institute of Surgical Research, Building R, Room 289-7, 3400 Rawley Chambers, Fort Sam Houston, TX 78234

Investigation performed at the United States Army Institute of Surgical Research, Fort Sam Houston, Texas

NOTE: The authors acknowledge the contributions of Terry G. Bice, MS, Thomas M. Deberardino, MD, E. Schuyler DeJong, MD, Roman A. Hayda, MD, John B. Holcomb, MD, John F. Kragh, MD, Seth S. Leopold, MD, Keith T. Lonergan, MD, Aimee R. Moreau, MS, Dean C. Taylor, MD, and Fonzie J. Quance-Fitch, DVM.

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. Wright Medical provided the authors' institution with materials for testing at no cost.

The views expressed herein are the private views of the authors and are not to be construed as representing those of the Department of the Army, the Department of Defense, or the United States government. No official endorsement should be inferred.

Background: The morbidity associated with open fractures and open fracture treatment is well established. An osteoinductive and osteoconductive bone-graft substitute that prevents infection would decrease the number of procedures required to treat contaminated fractures by eliminating the need for surgical removal of cement beads and perhaps autograft harvest. We hypothesized that the combination of tobramycin-impregnated calcium sulfate pellets and demineralized bone matrix would prevent the establishment of infection in a contaminated fracture model.

Methods: A unicortical 12-mm-diameter defect was created in the proximal tibial metaphysis of twenty-nine Spanish goats. After contaminating the wounds with an infective dose of Staphylococcus aureus, we divided the animals into four groups. The negative control group received no treatment, the positive control group received tobramycin-impregnated polymethylmethacrylate beads, the demineralized bone matrix group received 2.5 mL of demineralized bone matrix, and the experimental group received tobramycin-impregnated calcium sulfate pellets with 2.5 mL of demineralized bone matrix. Radiographs were made and intraosseous tissue cultures were performed on postoperative day 21.

Results: The cultures showed no evidence of intramedullary infection in the experimental or the positive control group, but they were positive for Staphylococcus aureus in six of the seven goats in the negative control group and seven of the eight goats in the demineralized bone matrix group.

Conclusions: The combination of tobramycin-impregnated calcium sulfate pellets and demineralized bone matrix was effective in preventing intramedullary Staphylococcus aureus infection in a contaminated goat fracture model.

Clinical Relevance: The local delivery of antibiotic with growth enhancers can prevent the establishment of intramedullary infection in association with open fractures. Such a combination therapy could potentially eliminate the need for surgical removal of cement beads and reduce the number of autografts harvested, thereby reducing the morbidity of open fracture treatment.


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