Implant-Related Infection in the Tibia: Surgical Revision Strategy with Vancomycin Cement

Figure 1

A patient sustained a Gustilo III A fracture in the tibia and received a plate-and-screw fixation. Two weeks later, there was infection on the wound. After debridement, persisting irrigation, and temporary reservation of the hardware for another two weeks, there were no signs of healing (a). The plate of the tibia was removed and replaced by assembled external fixators. A dead bone could be seen on the X-film and was later removed (b). After sufficient debridement, a custom-made vancomycin cement rod wias was inserted into the sinuses and the intramedullary cavity (c). Six months after the surgery, the sinuses and the osteomyelitis healed (d). Eighteen months after our surgery, both the wound and the bone healed uneventfully ((e), (f)).

(a)

(b)

(c)

(d)

(e)

(f)