Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients

Finelli, Carlos Augusto; Reis, Fernando Baldy dos; Fernandes, Hélio Jorge Alvachian; Dell’Aquila, Adriana; Carvalho, Rogério Teixeira de; Miki, Natália; Franciozi, Carlos Eduardo da Silveira; Abdalla, René Jorge; Salles, Mauro José Costa

doi:10.1186/s13037-019-0215-3

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…The baseline characteristics of the patients included in the study demonstrated a predominance of male patients with a mean age of 39.76 years. This is consistent with previous studies that have reported a higher incidence of these types of fractures in male patients and that these injuries tend to occur in younger patients [ 8 , 9 ]. In terms of fracture grade, 46.7% of the patients had GA grade 3 fractures, indicating a more severe type of injury.…”

Section: Discussionsupporting

confidence: 93%

Results of Antibiotic-Impregnated Cement/Polymer-Coated Intramedullary Nails in the Management of Infected Nonunion and Open Fractures of Long Bones

Solanki,

Maurya,

Singh

2023

Cureus

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Background Fractures of long bones can sometimes lead to complications such as infection or nonunion, resulting in significant patient morbidity. Surgical intervention and antibiotics are often necessary to treat these complications. Antibiotic-impregnated cement/polymer-coated intramedullary nails have emerged as an effective surgical treatment for infected nonunion and open fractures. These implants elude high concentrations of antibiotics at the infection site while stabilizing the fracture. Extensive research has shown promising results, with success rates ranging from 60% to 100%. Benefits of these implants include stable fracture fixation, early weight-bearing, and reduced need for prolonged antibiotic therapy. However, concerns remain regarding antibiotic resistance and potential toxicity. This study aims to evaluate the efficacy and safety of these implants in managing infected nonunion and open fractures of the femur and tibia. Methods This prospective hospital-based study aimed to assess the efficacy and safety of antibiotic-impregnated cement/polymer-coated intramedullary nails for managing infected nonunion and open fractures of the femur and tibia. The study included patients aged 18 or older who received treatment with these implants between January 1, 2021 and December 31, 2022. Patients allergic to vancomycin or teicoplanin, with gap nonunion >2 cm, or lost to follow-up were excluded. Data on demographics, fracture details, previous treatment, surgery, antibiotics, and outcomes were collected using a structured proforma. Surgeries involved implant removal, debridement, culture testing, reaming, fracture reduction, and stabilization with an antibiotic-impregnated cement/polymer-coated intramedullary nail. Postoperatively, patients received antibiotics, had wound inspections, and were gradually allowed weight-bearing. Follow-up appointments and radiographic/laboratory assessments were conducted at regular intervals. The primary outcome was successful bone union, and secondary outcomes included time to union, infection rate, nonunion rate, and revision surgery. Results The majority of participants were male, with a mean age of 39.76 years. Most fractures were Gustilo-Anderson grade 3 (46.7%) and involved the tibia (73.3%). The mean bone gap after debridement was 1.3 cm. The median follow-up period was 8.21 months. Infection was controlled in 93.3% of patients, with the tibia being the most common site (70.0%). Successful bone union was achieved in 90.0% of patients, with a mean union rate of 22.13 weeks for tibial fractures and 17.21 weeks for femoral fractures. Among patients with bone union, 60.0% did not require additional procedures. Most patients had excellent bony (76.7%) and functional (70.0%) outcomes. The most common complications were the persistence of bone nonunion, impingement of proximal nail, and debonding of nail cement, each occurring in 10.0% of patients. Conclusion The study concluded that antibiotic...

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Section: Discussionsupporting

confidence: 93%

Results of Antibiotic-Impregnated Cement/Polymer-Coated Intramedullary Nails in the Management of Infected Nonunion and Open Fractures of Long Bones

Solanki,

Maurya,

Singh

2023

Cureus

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“…Another treatment option with recently reported good results for medullar cavity reaming and lavage is the combined use of the reamer-irrigator-aspirator (RIA) system and antibiotic-coated nails (Kanakaris et al, 2014;Finelli et al, 2019). By using the RIA system, surgeons do not need to create a bone window, and, therefore, the procedure morbidity is reduced.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis – comparative analysis of custom-made versus commercially available nails

Garabano

Sel

Rodríguez

et al. 2021

J. Bone Joint Infect.

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Abstract. Background: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement–nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results: Thirty patients were included. The affected bones were the femur (n=15) and the tibia (n=15). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement–bone debonding. Commercial nails were associated with shorter operating times (p<0.0001). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement–bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.

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“…Although a limited number of studies investigated the efficacy of the RIA‐system for the treatment of long bone FRI, 10,15,16 our study is, to the best of our knowledge, the first to compare standard tissue cultures to cultures obtained using the RIA‐system for the diagnosis of FRI. A recent randomized controlled trial compared the RIA‐system to standard intramedullary reaming for the treatment of FRI 16 . Although tissue cultures retrieved by the RIA‐system were included as a diagnostic modality in that study, no comparison was made between sampling methods.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary tissue cultures from the Reamer‐Irrigator‐Aspirator system for diagnosing fracture‐related infection

Onsea

Pallay²,

Depypere³

et al. 2020

Journal Orthopaedic Research

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Fracture‐related infection (FRI) is a serious complication following musculoskeletal trauma. Accurate diagnosis and appropriate treatment depend on retrieving adequate deep tissue biopsies for bacterial culture. The aim of this cohort study was to compare intraoperative tissue cultures obtained by the Reamer‐Irrigator‐Aspirator system (RIA)‐system against standard tissue cultures obtained during the same surgical procedure. All patients had long bone fractures of the lower limbs and were assigned to the FRI or Control group based on the FRI consensus definition. The FRI group consisted of 24 patients with confirmed FRI and the Control group consisted of 21 patients with aseptic nonunion or chronic pain (in the absence of other suggestive/confirmatory criteria). Standard tissue cultures and cultures harvested by the RIA‐system showed similar results. In the FRI group, standard tissue cultures and RIA cultures revealed relevant pathogens in 67% and 71% of patients, respectively. Furthermore, in four FRI patients, cultures obtained by the RIA‐system revealed additional relevant pathogens that were not found by standard tissue culturing, which contributed to the optimization of the treatment plan. In the Control group, there were no false‐positive RIA culture results. As a proof‐of‐concept, this cohort study showed that the RIA‐system could have a role in the diagnosis of FRI as an adjunct to standard tissue cultures. Since scientific evidence on the added value of the RIA‐system in the management of FRI is currently limited, further research on this topic is required before its routine application in clinical practice.

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Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients

Cited by 10 publications

References 28 publications

Results of Antibiotic-Impregnated Cement/Polymer-Coated Intramedullary Nails in the Management of Infected Nonunion and Open Fractures of Long Bones

Results of Antibiotic-Impregnated Cement/Polymer-Coated Intramedullary Nails in the Management of Infected Nonunion and Open Fractures of Long Bones

The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis – comparative analysis of custom-made versus commercially available nails

Intramedullary tissue cultures from the Reamer‐Irrigator‐Aspirator system for diagnosing fracture‐related infection

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