{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:15:31Z","timestamp":1783480531545,"version":"3.55.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>High-grade open fractures carry a significant risk of osteomyelitis, despite advancements in surgical techniques and treatment protocols. The use of prophylactic, adjuvant local antibiotics is controversially discussed in the literature. CERAMENT\u00aeG (BONESUPPORT\u2122) is a novel synthetic bone substitute that effectively elutes gentamicin. This report presents the largest and longest follow-up data collected over the past decade, comparing these findings to our previous findings to identify long-term complications, as well as comparing the outcome against other forms of local antibiotic prophylaxis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective, descriptive analysis was conducted on patients with Gustilo\u2013Anderson IIIb fractures treated with CERAMENT\u00aeG as an adjunct to the conventional fix-and-flap approach from June 2013 to August 2021. Patient demographics, orthoplastic interventions, microbiological findings, and the latest outcome data\u2014including union rates, infection rates, mortality, and amputation outcomes\u2014were extracted from electronic records up to April 2024.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Seventy-six patients with 78 fractures were included, with a mean follow-up period of 88.7\u00a0months. The primary union was achieved in 65 cases (83.3%), and secondary union following bone grafting was achieved in 5 of 13 non-union cases. Three mortalities were identified. Four cases required amputation due to osteomyelitis, flap failure leading to soft tissue infection, failure in bone reconstruction, and chronic pain. Superficial infections occurred in 33 cases (42.3%), and osteomyelitis in 4 cases (5.1%). No local or systemic adverse reactions, including ototoxicity, were reported.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>CERAMENT\u00aeG is a safe and effective option for local antibiotic delivery in high-grade open fractures as an adjunct to systemic antibiotic prophylaxis. Its adjunctive use significantly reduced the risk of osteomyelitis compared to systemic prophylaxis alone and was superior to PMMA beads alone. <\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13018-025-05765-5","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T12:01:37Z","timestamp":1750680097000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Adjuvant local antibiotic prophylaxis in Gustilo\u2013Anderson IIIb open fractures: up to 10\u00a0years follow-up on clinical outcomes and complications"],"prefix":"10.1186","volume":"20","author":[{"given":"Eito","family":"Asano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossai","family":"Hemat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Bin Sahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Pillai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"11","key":"5765_CR1","doi-asserted-by":"publisher","first-page":"6579","DOI":"10.1007\/s00402-023-04956-1","volume":"143","author":"J Zhang","year":"2023","unstructured":"Zhang J, et al. Predictors for infection severity for open tibial fractures: major trauma centre perspective. Arch Orthop Trauma Surg. 2023;143(11):6579\u201387.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"5765_CR2","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/00494755241232171","volume":"54","author":"D Chebli","year":"2024","unstructured":"Chebli D, Dhaif F, Ridha A, Schade A, Khatri C. A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries. Trop Doc. 2024;54(3):272\u201381. https:\/\/doi.org\/10.1177\/00494755241232171.","journal-title":"Trop Doc"},{"key":"5765_CR3","doi-asserted-by":"crossref","unstructured":"Conterno LO, Filho CRDS. Cochrane database of systematic reviews Antibiotics for treating chronic osteomyelitis in adults John Wiley & Sons: UK. 2009","DOI":"10.1002\/14651858.CD004439.pub2"},{"issue":"8","key":"5765_CR4","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1097\/00005373-198408000-00009","volume":"24","author":"RB Gustilo","year":"1984","unstructured":"Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742\u20136.","journal-title":"J Trauma"},{"issue":"7","key":"5765_CR5","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1302\/2046-3758.77.BJR-2018-0043.R1","volume":"7","author":"M Morgenstern","year":"2018","unstructured":"Morgenstern M, et al. The effect of local antibiotic prophylaxis when treating open limb fractures: a systematic review and meta-analysis. Bone Joint Res. 2018;7(7):447\u201356.","journal-title":"Bone Joint Res"},{"key":"5765_CR6","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/00003086-200003000-00028","volume":"372","author":"H David Moehring","year":"2000","unstructured":"David Moehring H, Gravel C, Chapman MW, Olson SA. Comparison of antibiotic beads and intravenous antibiotics in open fractures. Clin Orthopaed Relate Res. 2000;372:254\u201361. https:\/\/doi.org\/10.1097\/00003086-200003000-00028.","journal-title":"Clin Orthopaed Relate Res"},{"key":"5765_CR7","first-page":"197","volume":"138","author":"K Klemm","year":"1979","unstructured":"Klemm K. The treatment of infected osteosynthesis using gentamycin\u2014PMMA\u2014bead chains. Hefte Unfallheilkd. 1979;138:197\u2013200.","journal-title":"Hefte Unfallheilkd"},{"issue":"10","key":"5765_CR8","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1097\/BOT.0000000000001259","volume":"32","author":"C Caroom","year":"2018","unstructured":"Caroom C, et al. Intrawound vancomycin powder reduces bacterial load in contaminated open fracture model. J Orthop Trauma. 2018;32(10):538\u201341.","journal-title":"J Orthop Trauma"},{"issue":"4","key":"5765_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/OI9.0000000000000210","volume":"5","author":"A Aneja","year":"2022","unstructured":"Aneja A, et al. Does prophylactic local tobramycin injection lower open fracture infection rates? OTA Int. 2022;5(4): e210.","journal-title":"OTA Int"},{"issue":"4","key":"5765_CR10","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3390\/jfmk6040097","volume":"6","author":"C Perisano","year":"2021","unstructured":"Perisano C, et al. Antibiotic-coated nail in open Tibial fracture: a retrospective case series. J Funct Morphol Kinesiol. 2021;6(4):97.","journal-title":"J Funct Morphol Kinesiol"},{"issue":"1","key":"5765_CR11","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/jbm.b.10528","volume":"65","author":"M DiCicco","year":"2003","unstructured":"DiCicco M, et al. Tobramycin and gentamycin elution analysis between two in situ polymerizable orthopedic composites. J Biomed Mater Res B Appl Biomater. 2003;65(1):137\u201349.","journal-title":"J Biomed Mater Res B Appl Biomater"},{"issue":"9","key":"5765_CR12","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1302\/2046-3758.59.BJR-2016-0108.R1","volume":"5","author":"M Stravinskas","year":"2016","unstructured":"Stravinskas M, et al. Pharmacokinetics of gentamicin eluted from a regenerating bone graft substitute: in vitro and clinical release studies. Bone Joint Res. 2016;5(9):427\u201335.","journal-title":"Bone Joint Res"},{"issue":"1","key":"5765_CR13","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1128\/AAC.03676-14","volume":"59","author":"RP Howlin","year":"2015","unstructured":"Howlin RP, et al. Antibiotic-loaded synthetic calcium sulfate beads for prevention of bacterial colonization and biofilm formation in periprosthetic infections. Antimicrob Agents Chemother. 2015;59(1):111\u201320.","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"5765_CR14","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.jor.2019.03.013","volume":"16","author":"N Jahangir","year":"2019","unstructured":"Jahangir N, et al. The use of adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo Anderson type IIIB fractures. Prospect Rev J Orthopaed. 2019;16(3):278\u201382.","journal-title":"Prospect Rev J Orthopaed"},{"key":"5765_CR15","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jor.2020.01.012","volume":"18","author":"A Aljawadi","year":"2020","unstructured":"Aljawadi A, et al. Adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo Anderson IIIB fractures. Prospective review of 80 patients from the Manchester Ortho-Plastic unit. J Orthopaed. 2020;18:261\u20136. https:\/\/doi.org\/10.1016\/j.jor.2020.01.012.","journal-title":"J Orthopaed"},{"key":"5765_CR16","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.39103","author":"J Henry","year":"2023","unstructured":"Henry J, et al. Long-term follow-up of open Gustilo\u2013Anderson IIIB fractures treated with an adjuvant local antibiotic hydroxyapatite bio-composite. Cureus J Med Sci. 2023. https:\/\/doi.org\/10.7759\/cureus.39103.","journal-title":"Cureus J Med Sci"},{"key":"5765_CR17","unstructured":"BOAST\u2014Open Fractures. [Clinical Guideline] 2017 [cited 2024 26 March]; Available from: https:\/\/www.boa.ac.uk\/resource\/boast-4-pdf.html."},{"issue":"5","key":"5765_CR18","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u201383.","journal-title":"J Chronic Dis"},{"key":"5765_CR19","unstructured":"BONESUPPORT\u2122 AB. CERAMENT\u00ae: White Wound Drainage Advice Sheet for Healthcare Professionals. Lund, Sweden: BONESUPPORT\u2122 AB 2024. 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J Bone Joint Surg Rev. 2019;7(2): e1. https:\/\/doi.org\/10.2106\/JBJS.RVW.17.00197.","journal-title":"J Bone Joint Surg Rev"}],"updated-by":[{"DOI":"10.1186\/s13018-025-06104-4","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000}}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-025-05765-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-025-05765-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-025-05765-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T21:38:56Z","timestamp":1757194736000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-025-05765-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5765"],"URL":"https:\/\/doi.org\/10.1186\/s13018-025-05765-5","relation":{"correction":[{"id-type":"doi","id":"10.1186\/s13018-025-06104-4","asserted-by":"object"}]},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"assertion":[{"value":"29 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The sentence in the Discussion section was corrected.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 July 2025","order":7,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":8,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":9,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s13018-025-06104-4","URL":"https:\/\/doi.org\/10.1186\/s13018-025-06104-4","order":10,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Retrospective data collection approval from the ethics committee has been waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"610"}}