Continuous local antibiotic perfusion therapy: a prophylactic strategy for Gustilo–Anderson type III open fractures

Objectives: Managing Gustilo–Anderson type III open fractures remains a challenge in orthopaedic trauma. Continuous local antibiotic perfusion (CLAP) therapy serves as a potential adjunct for infection prevention. In this study, the authors evaluated the clinical outcomes in patients with Gustilo–Anderson type III open fractures treated using an orthoplastic approach with CLAP therapy. Design: Single-center retrospective review. Setting: Tertiary trauma and reconstruction center (2020–2023). Patients/Participants: Twenty-two patients (mean age, 54.8 years) with Gustilo–Anderson type III open fractures of the extremities were included. Intervention: All patients received CLAP therapy with gentamicin as an adjunct to systemic antibiotics, staged fixation, and orthoplastic soft tissue management. Main Outcome Measurements: Data included demographics, injury and hospitalization details, type of fixation and coverage, CLAP therapy dosage, union rate, time-to-union, and CLAP therapy-related complications. Results: Two patients (9%) developed infections within 9 months. Primary union was achieved in 20 patients (91%); the remaining 2 achieved union after secondary bone grafting (overall 100%). The mean time-to-union was 6.4 months, and the mean follow-up duration was 21.5 months. No systemic adverse effects attributable to CLAP therapy were observed. Conclusions: CLAP therapy, as an adjunct to intravenous antibiotics, debridement, soft tissue reconstruction, and staged fixation, resulted in a relatively low infection rate (9%) in a small (22 patients) series of Gustilo–Anderson type III open fractures and was associated with a high union rate (91% primary, 100% with secondary surgery) and no recognized complications directly attributable to CLAP therapy. However, the absence of a control group precludes conclusions regarding comparative effectiveness. Level of Evidence: Level IV.