Response to Zhu K et al.,Efficacy of Antibiotic Cement in Preserving Endoplants After Infection With Plate Exposure (DOI: 10.1089/sur.2022.382)

To the Editor:

Recently, we read in-depth an article titled “Efficacy of Antibiotic Cement in Preserving Endoplants After Infection with Plate Exposure” by Zhu et al. ¹ The author divided 23 patients with infection caused by exposed plate fixation after tibial plateau fracture into observation and control groups. After the implantation of antibiotic bone cement in the observation group, the incision was sutured and covered with vacuum sealing drainage (VSD). In the control group, VSD was used to cover the patient's wound after debridement. The results showed that antibiotic bone cement could effectively control infection and promote wound healing. We thank the authors for their contributions, however, we still disagree with some issues, and we hope to discuss them.

First, Hua et al. ² researched whether internal fixation should be retained after tibial plateau fracture infection should be considered comprehensively. If the broken end is stable, maintaining the internal focus can keep the fracture end steady, and the infection can be controlled until the fracture heals, which is conducive to preserving the function of the knee joint. If the infection is severe, internal fixation fails after debridement, and the stump is unstable, external fixation should be performed. Therefore, the results of this study were also affected by the stability of the plate fixation after exposure and the severity of the infection. Second, bone cement implantation syndrome (BCIS) is a unique complication of bone cement surgery, characterized by varying degrees of respiratory and circulatory dysfunction. Qin et al. ³ reported a case of chronic osteomyelitis of the left tibia (Cierny-Mader type II) in a 37-year-old male who developed BCIS after covering the infected bone surface with antibiotic bone cement. This suggests that using antibiotic bone cement to treat infection in plate-exposed patients with early tibial plateau fractures has a risk of causing BCIS.

At the same time, as the authors said, the sample size of this study was limited, and the follow-up time was short, which caused certain limitations to the study's overall design. In addition to the relevant risk factors mentioned in this study, Li et al. ⁴ believed that age, fracture type, severity of soft tissue injury, and internal fixation time were also risk factors for infection. Therefore, improving the assessment of relevant risk factors can enhance the accuracy of this study. Again, our thanks for the author's contribution to this article, and we appreciate and look forward to the author's responses to the above questions.