Combining Bone Substitutes and Vancomycin to Reduce Infection Rates in Pilon and Tibial Plateau Fractures

Fabio Lucas Rodrigues, MD; Letícia Alves Bueno, MD; Vanessa Aparecida de Oliveira, MD; Raoni Gomes Araujo, MD; Marcio Aurelio Aita, MD

Department of Locomotor System Diseases, Faculdade de Medicina do ABC, Santo André, Brazil.

Study Design: Retrospective, single-arm, non-randomized cohort study with 14 adult patients. Each patient had at least one infection risk factor, such as diabetes, smoking or soft-tissue injury.

Treatment Approach: Osteosynthesis with subchondral defect filling using PerOssal® loaded with vancomycin as an adjunct in surgical management. Radiographic follow-up assessed structural integrity and subsidence.

Results: Observed postoperative infection rate was 0% (0/14; 95% CI, 0.0%-23.2%). This was lower than the 40% historical reference (p=0.0008) and the 30% reference (p=0.0068). Maintenance of reduction at 6 months was 86.6% (95% CI, 57.2%-98.2%).

Conclusion: In this pilot cohort, antibiotic-loaded PerOssal® was associated with zero postoperative infections and adequate mechanical support to maintain fracture alignment in the majority of cases.

Take-home message: 0 infections in 14 high-risk fracture patients, supported by representative imaging of injury severity, fixation strategy and soft-tissue evolution.

Keywords: Tibial Plateau Fracture; Tibial Pilon Fracture; Calcaneus Fracture; High-Energy Trauma; Postoperative Infection; PerOssal®; Vancomycin.