Abstract

Local antibiotic therapy with gentamicin-PMMA chains and external fixation permit effective simultaneous therapy of both components of infected tibial pseudarthroses: sequestering osteomyelitis and pseudarthrosis. The local concentrations of gentamicin which can be achieved by implantation of gentamicin-PMMA chains are far above the MIC of most common pathogens. This form of local antibiotic therapy is superior to any form of systemic antibiotic therapy. The gentamicin-PMMA chains serve as well as space holders for the bone graft to promote bone consolidation in the absence of infection. The results can be improved by successful management of the soft tissue damage often associated with tibial pseudarthrosis. Pedicled or free muscle graft with microvascular anastomosis is the method of choice.