Study and analysis of effect of calcium sulphate augmented with antibiotics in orthopaedic practice

Abstract

Background: Open fractures, osteomyelitis, peri-prosthetic infections whether impending or established are challenging situations in orthopaedic practice. Prevention and eradication of infections is a difficult task and incomplete treatment can lead to devastating complications. Treatment protocol involves wound debridement in cases of osteomyelitis and peri-prosthetic infections, primary internal fixation of the open fracture and application of calcium sulphate augmented with antibiotics, is a line of treatment in most of the cases. Aim: To study and analyse the effect of calcium sulphate augmented with antibiotics in orthopaedic practice. Materials and Methods: Patients were admitted in Mallya Hospital, Bangalore in between June 2018 to December 2019. Sample size of 30 was calculated based on the formula. Patients with diagnosis of osteomyelitis, peri-prosthetic infection and open fracture were included in the study. The patients were recruited to the study after due consent. Clinical history was taken and patients were examined, laboratory parameters (TC, ESR, CRP) were taken preoperatively and radiological examination done. Patients were followed up with laboratory parameters (TC, ESR, CRP), radiographs for resorption of calcium sulphate and bone healing at 6 weeks, 3 months and 6 months postoperatively. Results: Minimum age of the patient was 15 years and maximum 83 years, 2 patients were lost to follow up, 21 males and 7 female patients. Cases were divided depending on the type. Postoperatively laboratory parameters with statistical significant P values in cases of osteomyelitis, peri-prosthetic infection, open fracture seen in TC, ESR and CRP are as follows, osteomyelitis (0.016,0.011, <0.001), Periprosthetic infection (<0.001, <0.001,<0.001) and in open fractures (<0.001, 0,003,<0.001). Calcium sulphate resorption was assessed along with bone healing. Average Calcium sulphate re-sorption period was 6 weeks and average bone healing time was 6 months in fracture and cases with the bone void formation. There was statistically significant difference between all the groups when compared pre and postoperatively. Conclusion: We concluded that antibiotic impregnated Calcium sulphate plays an important role in tackling the infection when used locally at the site of infection; it helps in wound healing and bone healing.