Treatment of chronic osteomyelitis with locally made calcium sulfate bone cement pellets impregnated with antibiotics at University Teaching Hospital of Butare (CHUB), Rwanda

Background
Chronic osteomyelitis remains a challenging and potentially lifelong disease. Its treatment includes surgery, which is essential and consists of the removal of all dead bone and necrotic soft tissues, and systemic antibiotic administration. One excellent modality for antibiotic delivery is the use of antibiotic-impregnated bone cement. In this paper, we report our experience of operating-room-made antibiotic-impregnated bone cement at University Teaching Hospital of Butare (CHUB), Rwanda.

Methods
Fifty-five patients with haematogenously spread chronic osteomyelitis were operated upon and benefited from our protocol between January 2015 and December 2016. Excluded from this study were cases in which we estimated that soft tissue bone coverage might have been a challenge. We mixed 300 g of calcium sulfate powder with 2 g of ceftriaxone and 480 mg of gentamicin to form pellets. To allow for drying, we prepared the mixture 2 hours before implantation into operated bone.

Results
Thirty-one patients (56%) were children under 15 years of age, and 44 (80%) of the cases involved the tibia or the femur. After 12 months of follow-up, only 3 cases (5%) presented with complications that needed additional surgeries. All complications were related to the biodegradation of the calcium sulfate pallets. The rest of the patients in this study improved without complications.

Conclusions
The locally made (within in the operating room) antibiotic-impregnated bone cement at CHUB was safe, effective, and of low cost.

Keywords
chronic osteomyelitis; bone cement; calcium sulfate; antibiotics; locally available materials; Rwanda