Therapy for Chronic Recurrent Osteomyelitis with Multi-Resistant Pseudomonas aeruginosa Using Local Antibiotic Release by a Polymethylmethacrylate Custom-Made Tibia Nail

Background: The treatment of chronic osteomyelitis by antibiotics administered intravenously is limited by the blood supply that is not present in bone sequestra. Local delivery of antibiotics using acrylic bone cement has been reported with favorable results for treatment of chronic osteomyelitis. Case Presentation: Treatment of a patient with recurrent osteomyelitis after a third- degree open tibia fracture at our hospital failed several times because of recurrent infection with Pseudomonas aeruginosa that later became multi-resistant. Suitable antibiotic treatment was limited to colistin that was mixed with polymethylmethacrylate (PMMA) matrix (Copal® G+C Plus, Heraeus, Hanau, Germany) and used to cover an Ender nail. The PMMA–tibia nail construct was placed intra-medullary for two weeks under appropriate antibiotics applied intravenously. The patient has been pain free for 18 months without any signs of infection and with normal blood tests. Conclusion: We provide evidence that colistin can be applied locally with Copal G+C providing appropriate concentration because of elution over a period of at least two weeks. This technique demonstrates a custom-made solution for patients with multi-resistant osteomyelitis for P. aeruginosa when conventional treatment fails.