Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

Abstract

Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection.

Intramedullary nails coated with Antibiotic Loaded Acrylic Cement (ALAC) containing 5% of culture specific antibiotic in therapy for infected long bone fractures and nonunions

“…Other indications include open diaphyseal fractures with soft tissue damage, infected nonunion and hematogenous osteomyelitis. The contraindication for ACIIN may be the bone defect of more than 6 cm [11]. Multiple techniques of making ACIIN were described starting from manual covering of the nail to injecting cement to the chest drain acting as a temporary mould and multiple use forms [12].…”

“…The contraindication for ACIIN may be the bone defect of more than 6 cm [11]. Multiple techniques of making ACIIN were described starting from manual covering of the nail to injecting cement to the chest drain acting as a temporary mould and multiple use forms [12]. The type of cement, antibiotic choice as well as its dose and concentration are still an open issue [13].…”

“…In one case ACIIN was used as 1st stage for steged reconstruction of diaphyseal segmental defect of femur with 11cm allograft and IMN. The ethiology of infection: S. aureus (11) including MSSA (3) and MRSA (8), Staph. Epidermidis (1) and one MRSA and Pseudomonas aeruginosa mixed infection.…”

Antibiotic Intramedullary Nail in the Management of Infected Ununited Tibial Fractures - Case Report, Technique and Review of Literature

“…In regards to selection of antibiotic, vancomycin and gentamicin are by far the most commonly used agents with minimal reports of systemic toxicity [20][21][22]. Gentamicin and vancomycin are broad spectrum antibiotics, stable for the exothermic reaction present in PMMA, work synergistically, and have been reported to increase elution rates when used simultaneously [21][22][23][24]. The optimal solution to antibiotic selection would be isolation of the offending organism and subsequent use of a targeted antibiotic mixed into the PMMA.…”

“…Buchholz and Engelbrecht pioneered the use of antibiotic cement for treatment of osteomyelitis and found antibiotic concentrations which were vastly higher and longer lasting than systemic or other local depot administration [5]. Bone cement loaded with antibiotics is easily customized to the size and shape necessary to function as an intramedullary nail, which fills dead space, stabilizes factures, and delivers a high dose of antibiotics to the zone of infection [6]. Paley published on a temporizing treatment for intramedullary infections after nailing which consisted of using a custom-made antibiotic impregnated cement rod which can be removed after 6 weeks and replaced with definitive metal intramedullary nail [7].…”