Intramedullary Delivery of Local Antibiotics Via Calcium Sulfate Beads for Chronic Osteomyelitis With a Simple, Novel Surgical Technique

Aim: The aim of this manuscript was to describe a novel surgical technique that can be used intraoperatively to aid in the management of chronic diaphyseal osteomyelitis through the delivery of antibiotics into the medullary canal. Technique: Following standard intramedullary and reamer irrigator aspirator preparation of the femoral canal, a negative-pressure gradient is created through the canal. A 32-Fr chest tube is placed antegrade down the femur and used as a conduit for delivering antibiotic beads. A 20-Fr chest tube can be used to manually piston the beads further down the canal. Uses, Outcomes, and Pitfalls: This technique can be used to administer prefabricated calcium sulfate antibiotic beads or hand-made antibiotic polymethylmethacrylate beads evenly throughout the medullary canal of long-bones. It is a simple, cost-effective, one-surgery solution to assist clinicians when managing patients presenting with this difficult problem.