Use of a Porous Alumina Antibiotic-Loaded Ceramic to Treat Bone Defect and Bone Infection After Road Trauma.

To describe the use of a porous alumina ceramic loaded with antibiotics for the reconstruction of bilateral tibial fractures in a patient who presented with bone loss and infection after a motorcycle road injury. A 70-year-old man presented open fractures of his both tibiae (proximal involvement on the right side and diaphyseal on the left side). After initial treatment with multiple débridements and the placement of bilateral external fixators, he had bone loss to both tibiae and had developed infections of both legs with multiple organisms identified (Stenotrophomonas maltophilia, Enterobacter cloacae, and Pseudomonas aeruginosa). We used a porous alumina ceramic, designed according to the defects to fill. This ceramic was loaded with antibiotics (gentamicin and vancomycin). The goal was to obtain locally high concentrations of antibiotics to eradicate bacteria that could have remain in the surgical wound. Ceramic parts were placed 4 months after the trauma. Local antibiotic concentrations largely exceeded the pharmacological parameters for antibiotics efficacy. External fixators were removed 3 months after implantation. After a follow-up of more than 1 year, there is no relapse of infection, and the patient resumed walking while ceramic parts were left in place and that bone started colonizing ceramic parts. This ceramic that combines strength and the possibility of antibiotic loading allows thinking of new ways to treat infected fractures with bone loss. Indeed, its mechanical strength provides primary stability, and antibiotics make it possible to secure implantation in an infected area.

Osteoid osteoma multifocally located and recurrent in the carpus.

The authors report a case of osteoid osteoma located simultaneously at the right carpitate and at the proximal part of the right third metacarpian. A 31-year-old man presented in 1997 an osteoid osteoma involving the right capitate. One year after the surgical excision of the tumor, a second osteoid osteoma reappears to the same place requiring a 2nd intervention. A 3rd osteoid osteoma was discovered 16 months later at the proximal part of the right third metacarpian. After every excision, the pathological aspect was compatible with a nidus of osteoid osteoma. Osteoid osteoma of capitate are very rare. Multifocal forms are exceptional. If relapses of the tumor are sometimes explained by the incomplete excision of the nidus, the pathogenesis of the true recurrence remains unclear.