This article presents our experience with the use of antibiotic-impregnated
calcium sulfate in the management of comminuted
open fractures with a bony defect caused by combat-related blast
injuries and high-energy
wounds.
Calcium sulfate was used 19 times in 15 patients (17 fractures) as a
bone graft substitute and a carrier for
antibiotics. The
anatomic sites of the
graft were as follows: 6 calcanei, 1 midfoot, 1
metatarsal, 5 tibiae, 3 femorae, and 1
humerus. The
average number of procedures
prior to grafting was 6.2 (range, 2-10;
median, 6) with grafting performed at an
average 28 days after
injury (range, 9-194 days;
median, 14 days).
Average radiographic follow-up of 12 fractures not requiring repeat grafting or amputation was 8.5 months (range 1-19 months;
median, 7 months), and all of these fractures demonstrated clinical and
radiographic evidence of
fracture healing and consolidation. Four patients subsequently underwent 5 transtibial amputations: 2 for persistent
infection, 1 when the patient changed his mind against limb salvage acutely, and 2 for severe
neurogenic pain. Including the 2 amputations for persistent
infection, 4 patients (22.2%) required further
surgical management of
infection. Three patients (17.6%) subsequently developed
heterotopic ossification at the
graft site, which required
surgical excision. Antibiotic-impregnated
calcium sulfate is effective in treating severe, contaminated
open fractures by reducing
infection and assisting with fracture union.
