Management of infections with antibiotic bone cement in trauma and orthopedic surgery

Background: Osteoarticular infections and major bone defects following high-kinetic trauma or arthroplasty remain significant challenges in orthopedic surgery, often resulting in severe functional impairment. While systemic antibiotic therapy is standard, its efficacy is frequently limited by poor local vascularization and the formation of bacterial biofilms on internal fixation devices.

Objective: This article evaluates the clinical indications, microbiological considerations, and therapeutic advantages of using antibiotic-impregnated bone cement in the management of open fractures, septic pseudarthroses, and prosthetic joint infections.

Key Points: The use of antibiotic-laden spacers is a critical component of the two-stage Masquelet technique, providing mechanical stability and promoting the formation of an induced membrane for subsequent bone grafting. Local delivery achieves tissue concentrations up to 1,000 times higher than systemic administration without increasing systemic toxicity. While gentamicin-impregnated cement is effective against common Gram-positive and Gram-negative pathogens during initial debridement, data suggest that dual-antibiotic combinations, such as gentamicin and clindamycin, are superior for preventing superinfections and inhibiting biofilm formation. In hemiarthroplasty for femoral neck fractures, high-dose dual-impregnated cement significantly reduces deep infection rates compared to low-dose single-antibiotic cement (1.1% vs 3.5%) without increasing bacterial resistance.

Conclusion: Antibiotic bone cement is an essential adjuvant tool that optimizes the management of complex osteoarticular infections. Utilizing dual-antibiotic formulations enhances antimicrobial synergy, reduces biofilm-related failures, and improves clinical outcomes in both trauma reconstruction and revision arthroplasty.