Prophylactic Vancomycin-PMMA Strips are an Easy-to-Use and equally effective alternative to antibiotic beads in open fracture care

Bijay Kumar Lamay, Sikata Nanda, Ramakanta Mohanty, Rabi Narayan Dhar, Priyaranjan Acharya

Abstract


Objectives: Even under ideal conditions, infection remains a risk of surgery and can be harrowing after
surgical repair of compound fractures. This study aimed to assess the efficacy and convenience of local
antibiotic-impregnated polymethyl methacrylate (PMMA) strips to overcome infection and functional
union within a specified time after primary definitive stabilization of compound fractures.
Design:We investigated patients who received PMMA-vancomycin strips during orthopedic surgical repair
of open fractures.
Setting: From 2017 to 2019 in a tertiary medical center.
Patients: A total of 106patients with open fractures type I through IIIC were included (age range, 24–62
years).
Intervention: Patients underwent profuse wound cleaning, methodical debridement, and definitive stabilization with PMMA-vancomycin strips.
Main Outcome Measurements: We measured the incidence of wound healing, fracture union, and infection rate. Patients were followed for two years with infection parameters and radiographs. The efficacy of the PMMA strips in our study with that of PMMA beads in similar procedures from published studies
was compared.
Results: Of 106patients, five (4.7%) had a subclinical infection until implant removal. We found no osteomyelitis or non-union in any patient. A literature search confirmed comparable outcomes in infection rates between the PMMA strips used in this study and antibiotic beads used in previous studies. However,
the removal of PMMA vancomycin strips is generally more convenient compared with that of beads.
Conclusions: For the controversial challenge of determining the duration to keep or remove antibiotic beads, PMMA vancomycin strips present surgeons with an easy-to-use alternative with equivalent efficacy.

Keywords: Vancomycin, Polymethyl methacrylate, Beads, Strip.


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