Abdul Mateen, Ali M Shami, Ali Akhtar, Kashif A Memon, Zulqurnain Rafiq.
Evaluation of Vancomycin impregnated Polymethylmethacrylate beads for the treatment of chronic Osteomyelitis patients admitted in PIMS.
J Surg Jan ;27(1):26-34.

To evaluate the effectiveness of Vancomycin - Polymethylmethacrylate beads for the treatment of chronic osteomyelitis. Material and Methods: This prospective, descriptive study of 34 patients was carried out at Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of 2 years from 1st January 2002 to 30th December 2003. All patients included in the study had to undergo a two stage procedure. In first stage, Vancomycin impregnated Polymethylmethacrylate (PMMA) bone cement beads were implanted after evacuation of all necrotic and scarred tissue, osseous sequestra and infected implant, if any, until the clinically viable bone was encountered. Second stage comprised of removal of the beads after an interval of 4 to 6 weeks. Results: Mean age of patients was 34.35 with a standard deviation of 11.31. Out of total of 34 patients, 73.5 % were males; percentage of female patients was 26.5. Most common bone involved in chronic osteomyelitis in our study was femur, being involved in 70.6%. Staphylococcus aureus was the most frequent pathogen isolated i.e. 67.6%. Success rate was 91.2% and failure of treatment was encountered in 8.8% cases. Conclusion: The antibiotic impregnated beads as a therapeutic regime possess certain benefits over other kind of treatment modalities like, high local antibiotic levels, management of dead space, low incidence of allergic reactions, minimal side effects, and cost effectiveness. We therefore suggest that Vancomycin-PMMA beads should be included in the armamentarium for the treatment of chronic osteomyelitis.

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