Injection of an Antibiotic-Impregnated Flowable Bone Cement to Treat Osteomyelitis - Description of a Novel Surgical Technique

Introduction: Chronic osteomyelitis, affecting up to 30% of wound cases, is increasing due to diabetes, peripheral vascular disease, and resistant bacteria. It causes significant morbidity, functional impairment, and often recurs after treatment. A new flowable antibiotic-impregnated bone cement* has shown success in treating refractory cases. This abstract presents a novel surgical technique utilizing this product to treat diabetic foot infections.Methods:The first step is confirming the presence of refractory osteomyelitis. After determining the need for surgical intervention, injector ports are placed in the target bones under fluoroscopic imaging in the operating room. One injection and one vent port are used for metatarsals, one or two for cuboid and navicular, and three to five for talus and calcaneus. Misplaced or non-functional ports should be left in place to prevent cement leakage into soft tissue. Ports must not be placed through the wound to avoid contamination. Bone and tissue samples are obtained for analysis before preparing the cement as per manufacturer instructions, with slightly more liquid for a less viscous solution and extended setting time. The cement is transferred to 3cc syringes and injected simultaneously through ports using a three-way valve, ensuring the cement fills the bone completely without leaving void spaces. The cement sets within 10-12 minutes, and any resistance to flow generates heat, which accelerates the setting; therefore, cooling the ports with saline may be necessary. Fluoroscopic imaging is done at baseline, after port placement, during injection, and post-injection. Ports are removed after 15 minutes, and the wounds are closed using standard techniques. Antibiotic beads may be used if needed, and regular wound care is continued.Results:This novel surgical technique is relatively easy to perform. It requires standard equipment from the operating room and leads to good preservation outcomes.Discussion: This bone preservation technique aligns with established limb salvage protocols. It is generally sufficient to treat refractory cases; however, if the infection persists, the procedure can be repeated, or amputation of the infected bone, the traditional gold standard, may be considered.References: