The use of antibiotic infused bone cement to maintain correction following minimally invasive bunionectomy infection authors

Abstract

Minimally invasive surgical techniques are becoming increasingly popular in foot and ankle surgery. Recent literature suggests that when used as an alternative to open techniques for mild to moderate symptomatic hallux valgus correction, similar patient outcomes and surgical correction may be obtained. However, there is concern amongst many surgeons given the reported high complication rates, and lack of long term follow up. A paucity of studies within the literature have described the management of post-operative infections following a minimally invasive bunionectomy. We present a case report of a 66-year-old male who developed a postoperative infection following a minimally invasive bunionectomy procedure, who was successfully treated utilizing an innovative technique. Four weeks postoperatively, the patient developed a surgical site infection requiring admission for IV antibiotics and further work-up. An MRI revealed findings concerning for osteomyelitis of the first metatarsal head. The patient underwent surgical debridement with hardware removal, followed by insertion of vancomycin infused polymethylmethacrylate bone cement. The antibiotic cement was placed within the intramedullary canal to buttress the first metatarsal osteotomy site in order to maintain correction. Postoperatively, the patient completed a six-week course of IV antibiotics and healed without complication. The patient returned to unrestricted activity by 10 weeks post-operatively, and is currently pain free without signs of infection or loss of correction with the antibiotic cement still in place two years after the index procedure.

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