Commercially available antibiotic-laden PMMA-covered locking nails for the treatment of fracture-related infections - A retrospective case analysis of 10 cases

Abstract

Abstract. Introduction: Fracture-related infections (FRIs) are a devastating complication. FRIs are challenging and should be addressed with a multidisciplinary approach. An FRI should be addressed surgically by non-viable bone debridement, local antibiotic deposition, minimization of dead space and fracture stabilization. Antibiotic-laden PMMA-covered nails are a viable option to face these complications. To demonstrate the safety and utility of commercially available antibiotic-laden PMMA-covered nails, we performed a review of the cases operated in our institution and a cost analysis to compare the cost of a commercial nail to other available alternatives.Material and methods: We designed a retrospective study of consecutive cases to demonstrate the safety and efficacy of antibiotic-laden PMMA-covered commercial nails and designed a cost analysis of commercial coated nails compared to other custom-made alternatives.Results: We treated seven tibias and three femurs. Nine patients fully fit the criteria for FRI. There was one case of reintervention because of persistent drainage. All fractures healed, and in the first year post-intervention, there were no signs or symptoms of infection. There were no complications related to the commercially available nail that was used. There is a small increase in the direct quantifiable cost in commercially available nails, but non-quantifiable cost should be assessed individually.Conclusions: Commercially available antibiotic-laden PMMA-covered nails are a safe and useful treatment option for complicated cases of lower limb long bone reconstruction. The low complication rate and the straightforward technique compensate for the direct cost increase in most situations.

Management of Postoperative Infection After Fixation of a Delbet Type III Pediatric Femoral Neck Fracture

“…This provided stability to protect the blood supply, preventing osteonecrosis while delivering local antibiotics to the infection site. This is similar to how antibiotic-coated cement rods have successfully treated intramedullary long bone infections 7,8 .…”

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

“…Local carbapenems, which have been previously shown that they can be safely added to PMMA bone cement, could be a valuable option in these cases [36]. Hence, approaches involving vancomycin and gentamicin, but also carbapenemcarrying bone substitutes, bone cement or coated implants seem reasonable [37][38][39]. However, further studies investigating clinical outcomes, safety for the treated patient and influence of resistance profiles in microbiological environment are required.…”

Outcomes of Various Antibiotic Cement–Coated Intramedullary Implants on the Treatment of Long Bone Septic Nonunion

“…Finally, industry has moved to make bioabsorbable antibiotic coatings 23 and a static, rigid, interlocking nail that comes precoated with a poly D,L-lactic acid matrix impregnated with gentamicin for the use in acute open tibial fractures, aimed to reduce the infection rate in these injuries that have also been described as useful in nonunion treatment. 24–27…”