European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
Antibiotic-loaded synthetic calcium sulfate (Stimulan) in the surgical management of fracture-related complications in a low-middle income country.
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Atkinson Kate V, Yusup Ilziba, Slack Emma, Chan Chaplin C L, Hy Lyann C, Sambath Hong P, Koh Niak Puei, Noor Saqib, Gollogly James G
Аннотация
PURPOSE: The use of calcium sulfate antibiotic delivery systems are underreported in low- and middle-income countries (LMICs), despite the high burden of fracture-related infections and complications. This study evaluates the use of Stimulan in fracture-related complications in a resource-limited setting.
METHODS: A prospective analysis was conducted of all patients treated with Stimulan (Biocomposites Ltd., Keele, UK) for fracture-related complications, between July-September 2023 at Children's Surgical Centre, Cambodia. Patients were followed up regularly at six, nine, and 12 months post-operatively and assessed on the following outcomes: radiological union, radiological/clinical infection remission and functional outcome.
RESULTS: Five out of six patients (83.3%) treated for FRI were clinically and radiologically infection-free, and six out of eight patients (75%) achieved fracture union, at 12 months follow-up. Surgical wounds had healed with no evidence of infection in seven (87.5%) patients. Five non-unions (71.4%) had radiologically healed by 12 months. All patients were fully weightbearing at one year, with two (25%) still requiring walking aids.
CONCLUSION: The use of Stimulan in LMICs appears to provide an effective adjunct for managing fracture-related complications, however more research is required to investigate its efficacy in the treatment of infected non-unions in a LMIC setting.
METHODS: A prospective analysis was conducted of all patients treated with Stimulan (Biocomposites Ltd., Keele, UK) for fracture-related complications, between July-September 2023 at Children's Surgical Centre, Cambodia. Patients were followed up regularly at six, nine, and 12 months post-operatively and assessed on the following outcomes: radiological union, radiological/clinical infection remission and functional outcome.
RESULTS: Five out of six patients (83.3%) treated for FRI were clinically and radiologically infection-free, and six out of eight patients (75%) achieved fracture union, at 12 months follow-up. Surgical wounds had healed with no evidence of infection in seven (87.5%) patients. Five non-unions (71.4%) had radiologically healed by 12 months. All patients were fully weightbearing at one year, with two (25%) still requiring walking aids.
CONCLUSION: The use of Stimulan in LMICs appears to provide an effective adjunct for managing fracture-related complications, however more research is required to investigate its efficacy in the treatment of infected non-unions in a LMIC setting.