Post-op Rx/CT (August 2014)

The efficacy of injectable biphasic calcium sulphate/hydroxyapatite bone substitute Cerament™ G in the treatment of severe bone infections

C.Pempinello, P.Mallano, S.Pagliuca, G.Pennacchio, A.SepeaDepartment of Orthopaedic and Traumatology-S.Gennaro Hospital, Napoli bDepartment of Orthopaedic and Traumatology-S.G.Bosco Hospital, Napoli

cDepartment of Orthopaedic and Traumatology Nola Hospital

ResultsResultsCerament™ G gives good elution of antibiotic and allows bone ingrowth. The implantation of Cerament™ G was associated with good clinical outcomes and satisfactory bone consolidation

Displaced femur and heel fractures with

femural nail and skeletal

traction/external fixator (January 2014)

D.G. 58 years-old, male, was D.G. 58 years-old, male, was wounded by a bullet gunshot wounded by a bullet gunshot about 20 years before and was about 20 years before and was surgically treated. Later on,the surgically treated. Later on,the external fixator was removed, a external fixator was removed, a screw was left inside with bullet screw was left inside with bullet gunshot. He developed gunshot. He developed osteomyelitis with wound osteomyelitis with wound leakage. leakage. •Osteomyelitis and purulent Osteomyelitis and purulent secretion (MSSA)secretion (MSSA)•Rx/CT scan showing septic bone Rx/CT scan showing septic bone loss with screw and bullet gun shot.loss with screw and bullet gun shot.•DebridementDebridement•Cerament G was added.Cerament G was added.•Follow-up: wound healing, no Follow-up: wound healing, no infection relapse, bone infection relapse, bone consolidationconsolidation

Osteomylelitis with bullet gunshot and screw left inside

Clinical view and Rx /CT scan 3 months later

Bone consolidation (September 2015)

IIntroductionntroductionAutologous bone grafting for bone defect reconstruction is associated with complications including donor site morbidity, infection risk, pain and Autologous bone grafting for bone defect reconstruction is associated with complications including donor site morbidity, infection risk, pain and

surgical time. Therefore, bone graft substitutes provide an alternative for distinct indications and different characteristics with regard to their mechanical surgical time. Therefore, bone graft substitutes provide an alternative for distinct indications and different characteristics with regard to their mechanical properties and resorption rates. In order to fill the loss of bone substance and to control the infection, we tried the efficiency of Cerament™|G, a new properties and resorption rates. In order to fill the loss of bone substance and to control the infection, we tried the efficiency of Cerament™|G, a new absorbable composite of Calcium Sulphate and Hydroxyapatite with Gentamicinabsorbable composite of Calcium Sulphate and Hydroxyapatite with Gentamicin. . Materials and methodsMaterials and methods

We present 3 male patients aged between 45 and 68 years affected by post-traumatic severe septic non union of femur, tibia and foot. The first We present 3 male patients aged between 45 and 68 years affected by post-traumatic severe septic non union of femur, tibia and foot. The first patient with femur and foot fracture falled from height in a work accident (patient with femur and foot fracture falled from height in a work accident (MRSAMRSA), the second one had a chronic femoral osteomyelitis several years after a ), the second one had a chronic femoral osteomyelitis several years after a bullet gunshot(bullet gunshot(MSSAMSSA). Third patient with displaced and comminuted femur fracture was involved in a car accident (mixed flora ). Third patient with displaced and comminuted femur fracture was involved in a car accident (mixed flora Acinetobacter Baumanii, Acinetobacter Baumanii, MRSAMRSA,KPC-producing).The third patient had several operations including multiple bone resection, debridement with external fixator, occlusion of ,KPC-producing).The third patient had several operations including multiple bone resection, debridement with external fixator, occlusion of superficial femoral artery with arterial bypass and finally debridement with implantation of Cerament™ G with external fixator and long term antibiotic superficial femoral artery with arterial bypass and finally debridement with implantation of Cerament™ G with external fixator and long term antibiotic therapy. Clinical and radiographic outcome were assessed at follow-up (mean 8 months; range 4-18) therapy. Clinical and radiographic outcome were assessed at follow-up (mean 8 months; range 4-18) ResultsResults

The follow-up was 4-18 months with examining clinical, radiographic, CT scan and laboratory tests. The patients had self-limiting fluid leakage. The follow-up was 4-18 months with examining clinical, radiographic, CT scan and laboratory tests. The patients had self-limiting fluid leakage. There was no recurrence of infection during the follow-up period. Bone ingrowth occurred in all casesThere was no recurrence of infection during the follow-up period. Bone ingrowth occurred in all cases..

Cavitary defects with Cerament G

June 2015

CT : partial consolidation (January/June 2015)

Severe osteomyelitis, debridement (February 2014)

Debridement/Cerament G (August 2014)

2° application of Cerament G (June 2015)

C.R. man, 42 years old, C.R. man, 42 years old, presented displaced femur presented displaced femur fracture and heel fracture (type fracture and heel fracture (type IV IV Sanders classification)Sanders classification) by by work accident falling from work accident falling from heightsheights• Femoral nail and trans-skeletal Femoral nail and trans-skeletal

traction with external fixator traction with external fixator (January 2014).(January 2014).•Osteomyelitis, wound leakage, Osteomyelitis, wound leakage,

debridement. Septic bone resection debridement. Septic bone resection with 2 residual bone cavities with 2 residual bone cavities (February 2014).(February 2014).• Debridement with first apposition Debridement with first apposition

of Cerament G (June 2014) of Cerament G (June 2014) • Follow-up at 1 years shows: partial Follow-up at 1 years shows: partial

bone consolidation, full bone consolidation, full weightbearing, and no relapse of weightbearing, and no relapse of infection. Persistence of bone lossinfection. Persistence of bone loss