Septic Nonunion Of Radius and Ulna. Treatment with Calcium Sulphate Beads Impregnated With Antibiotic, Plate Fixation and Iliac Crest Autograft

Abstract

Introduction: Forearm fractures are common in young adults after direct trauma, such as traffic accidents, falls from height, and sports activities. Septic nonunion is defined as the failure of fracture consolidation and persistence of infection for 6-8 months. Factors contributing to its development include inadequate initial reduction, unstable fixation, early limb mobilization. In septic nonunions, influencing factors also include open fractures, extensive soft tissue damage, highly comminuted fractures, and patient-specific characteristics such as comorbidities.

Clinical case: A 43-year-old male, was admitted to the hospital due to severe pain and functional limitation in his left forearm. The current condition began while riding his motorcycle, he collided with an animal on the road, lost his balance, fell and suffered a discrete trauma to his left forearm, causing deformity, intense pain and a skin wound on the back of the forearm with bone exposure. He was initially treated in a first-level medical unit where mechanical lavage and wound closure were performed. Later he is sent to our unit. Surgical intervention was performed by open reduction of the left radius and ulna with a DCP plate in the radius and ulna.

Operative and postoperative course without complications. At 5 months of follow-up, he reported pain, edema, functional limitation and deformity. New radiographic studies are performed where loosening of osteosynthesis hardware, data of oligotrophic nonunion in the diaphyseal area of the radius and data of hypertrophic nonunion in the diaphyseal area of the ulna are observed.

Discussion: The therapeutic approach to septic non-unions presents a challenge for orthopedic physicians. Various management sequences have been described in the literature, with the gold standard being the eradication or reduction of the infectious load at the fracture site. Autografts play an important role in tendon, ligament and bone reconstruction surgery. calcium sulphate beads (Stimulan®) impregnated with vancomycin were used, specifically designed to fill dead space. Their ability to absorb antibiotics allows for effective, localized concentration maintenance, while promoting bone formation upon absorption.