EFFECTIVENESS OF LOCAL ANTIBACTERIAL CARRIERS IN PREVENTING INFECTIOUS COMPLICATIONS OF OPEN TIBIAL FRACTURES

Abstract

Severe open tibial fractures combine soft-tissue injury, contamination, impaired perfusion, and unstable bone fragments, creating conditions for biofilm formation and fracture-related infection. However, antibiotic delivery to devascularized tissues may be limited. Local antibacterial carriers, including powders, polymethylmethacrylate beads, calcium sulfate composites, and matrices, can produce high antimicrobial concentrations within the wound while reducing systemic exposure. They may also fill dead space after debridement and provide sustained drug release. Nevertheless, carrier behavior varies by material, antibiotic, bacterial susceptibility, drainage, and tissue condition. Excessive concentrations may impair cellular viability, nonabsorbable material may require removal, and uncontrolled use may promote resistance or wound leakage. Current trials support selected applications, but not routine use of every carrier or multidrug combination. Therefore, evaluation is needed to determine indications, safety, antibiotic loading, release characteristics, and effectiveness in tibial fractures. Such evidence could improve prevention without replacing systemic antibiotics, meticulous debridement, stable fixation, and timely soft-tissue coverage