Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

Gaby Hirsbrunner; A. Steiner

doi:10.1055/s-0038-1632603

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 1998; 11(01): 19-22
DOI: 10.1055/s-0038-1632603

Case Report

Schattauer GmbH

Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

Gaby Hirsbrunner

¹From the Clinic for Food Animals and Horses, Bern, Switzerland

,

A. Steiner

¹From the Clinic for Food Animals and Horses, Bern, Switzerland

› Author Affiliations

Abstract

Summary

A newborn calf was admitted for evaluation of a primarily closed comminuted metaphyseal fracture of metacarpus III/IV. Closed reduction and application of transfixation pins and a fibreglass cast were performed. Ten days after pin removal, radiographs revealed that the initially healed fracture had collapsed, and osteomyelitis was diagnosed. Bacteriological culture from the deep draining tract yielded Actinomyces pyogenes and Staphylococcus aureus. Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation, and long-time administration of antibiotics. In this case, we used surgical debridement, administration of a new long-acting local antibiotic (gentamicin- impregnated collagen sponges), and minimal external stabilization. At day 27 after initiation of this treatment, the skin defect had healed, and the fracture was stable on manual palpation.

Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation and prolonged administration of antibiotics. In the case described, we used surgical debridement, administration of a long-acting local antibiotic (gentamicin-impregnated collagen sponges), and minimal external stabilization. The promising outcome of this case and the good results in human surgery warrant further investigation in the use of gentamicin-impregnated collagen sponges in veterinary orthopaedics.

Keywords

Calf - metacarpus III/IV - osteomyelitis - delayed union - gentamicin-impregnated collagen sponges

Full Text

References

REFERENCES
1 Németh F, Back W. The use of the walking cast to repair fractures in horses and ponies. Equine Vet J 1991; 23: 32-6.
2 Farrow CS. The radiologic investigation of bovine lameness associated with infection. Vet Clin North Am (Food Anim Pract) 1985; 1: 67-81.
3 Moll HD, Modransky PD, Pleasant RS.. Use of a type II external skeletal fixator for repair of delayed union in three calves with forelimb fractures. J Am Vet Med Assoc 1995; 206: 1752-5.
4 Sumner-Smith G. Delayed unions and nonunions. Vet Clin North Am (Small Anim Pract) 1991; 21: 745-60.
5 Woodard JC, Riser WH. Morphology of fracture nonunion and osteomyelitis. Vet Clin North Am (Small Anim Pract) 1991; 21: 813-44.
6 Firth EC. Specific orthopedic infections. In Equine surgery.. 1st ed. Auer JA. (ed). Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: W.B.: Saunders Company. 1992: 932-9.
7 Greenough PR, McCallum FJ, Weaver AD. Miscellaneous conditions of bones. In Lameness in cattle.. 2nd ed. Weaver AD. (ed). Bristol: Wright Scientechnica; 1981: 328-32.
8 Rudd RG. A rational approach to the diagnosis and treatment of osteomyelitis. Compend Cont Educ Pract Vet 1986; 8: 225-32.
9 Trent AM, Plumb D. Treatment of infectious arthritis and osteomyelitis. In Applied pharmacology and therapeutics I, vol 7.. Hinchcliff KW, Jernigan AD. (eds). Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: W.B.: Saunders Company; 1991: 747-78.
10 Barneveld A. Cancellous bone grafting in the treatment of bovine septic physitis. Vet Quart 1994; 16: S104-7.
11 Firth EC, Kersjes AW, Dik KJ, Hagens FM. Haematogenous osteomyelitis in cattle. Vet Rec 1987; 120: 148-52.
12 Stickle RL, Cantwell HD, Tippett FE, Blevins WE. Focal metaphyseal osteomyelitis following open fracture in three horses. J Am Vet Med Assoc 1983; 183: 797-8.
13 Braden TD. Posttraumatic osteomyelitis. Vet Clin North Am (Small Anim Pract) 1991; 21: 781-811.
14 Martens RJ, Auer JA, Carter GK. Equine pediatrics: Septic arthritis and osteomyelitis. J Am Vet Med Assoc 1986; 188: 582-5.
15 Welker B. Osteomyelitis. In Current veterinary therapy.. 3 ed. Howard JL. (ed). Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: W.B.: Saunders Company; 1993: 881.
16 Nunamaker DM. Management of infected fractures. Vet Clin North Am (Small Anim Pract) 1975; 5: 259-71.
17 Neugebauer R. Die Behandlung der posttraumatischen Osteitis. In Kollagen als Wirkstoffträger.. Stemberger A, Ascherl R, Lechner F, Blümel G. (eds). Stuttgart, New York: Schattauer; 1989: 54-69.
18 Weaver AD. Chronic localized osteomyelitis of the bovine limb. Br Vet J 1972; 128: 470-6.
19 Hierholzer G, Allgöwer M, Rüedi T. Indikation der Fixateur-externe-Osteosynthese. In Fixateur-externe-Osteosynthese.. Hierholzer G, Allgöwer M, Rüedi T. (eds). Berlin, Heidelberg, New York, Tokyo: Springer Verlag; 1985: 15-6.
20 Tomlinson J. Complications of fractures repaired with casts and splints. Vet Clin North Am (Small Anim Pract) 1991; 21: 735-44.
21 Ascherl R, Stemberger A, Geissdörfer K, Claudi B, Machka K. et al. Experimented Ergebnisse und erste klinische Erfahrungen mit Kollagen-Gentamicin als Zusatzmaßnahme bei der chronischen Osteomyelitis. In Kollagen als Wirkstoffträger.. Stemberger A, Ascherl R, Lechner F, Blümel G. (eds). Stuttgart, New York: Schattauer; 1989: 45-53.
22 Plenderleith RWJ. Treatment of cattle, sheep and horses with lincomycin: Case studies. Vet Rec 1988; 122: 112-3.
23 Wörschhauser S, Rüter R.. Kollagen- Gentamicin in der Behandlung der Osteomyelitis. In Kollagen als Wirkstoffträger.. Stemberger A, Ascherl R, Lechner F, Blümel G. (eds). Stuttgart, New York: Schattauer; 1989: 75-9.
24 Steinig HJ.. Kollagen-Gentamicin in der Behandlung der Osteomyelitis. In Kollagen als Wirkstoffträger.. Stemberger A, Ascherl R, Lechner F, Blümel G. (eds). Stuttgart, New York: Schattauer; 1989: 70-4.
25 Stemberger A, Sorg KH, Machka K, Blümel G.. Technologische und biochemische Aspekte von Kollagen-Implantaten. In Kollagen als Wirkstoffträger.. Stemberger A, Ascherl R, Lechner F, Blümel G. (eds). Stuttgart, New York: Schattauer; 1989: 17-29.
26 von Hasselbach C. Klinik und Pharmakokinetik von Kollagen-Gentamicin als adjuvante Lokaltherapie knöcherner Infektionen. Unfallchirurg 1989; 92: 459-70.
27 Schneider RK, Renee A, Barnes HG. Use of antibiotic-impregnated polymethyl methacrylate for treatment of an open radial fracture in a horse. J Am Vet Med Assoc 1995; 207: 1454-7.
28 Tobias KMS, Schneider RK, Besser TE. Use of antimicrobial-impregnated polymethyl methacrylate. J Am Vet Med Assoc 1996; 208: 841-5.
29 Trostle SS, Hendrickson DA, Stone WC, Klohnen AAO. Use of antimicrobialimpregnated polymethyl methacrylate beads for treatment of chronic, refractory septic arthritis and osteomyelitis of the digit in a bull. J Am Vet Med Assoc 1996; 208: 404-7.
30 Hirsbrunner G, Steiner A. Bovine radiocarpal joint infective arthritis treated with gentamicin-impregnated collagen sponges. Vet Rec 1997 accepted for publication.
31 Steiner A, Hirsbrunner G. Use of gentamicin- impregnated collagen implants for treatment of chronic intrasynovial infections in ruminants: preliminary results. Vet Surg 1997; 26: 256.