Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia

Abstract

IntroductionInfected nonunion of long bones is a chronic and debilitating disorder. It is more difficult to deal with when the implant used for internal fixation itself becomes a potential media for infection because of bacterial adhesion and biofilm formation. Traditionally, it is managed by two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement coated nailing as single stage treatment modality for treating infection and achieving stability at the same time.Materials and MethodsTwenty patients (above 18 years of age) with infected nonunion of tibia with bone gap less than 2 cm were managed using antibiotic cement coated K-nail. Antibiotic cement nail was prepared using endotracheal tube method. Antibiotics used were a combination of vancomycin and teicoplanin.ResultsInfection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Remaining 8 patients required additional procedures like bone grafting or exchange nailing and these were done in six patients, with union of fracture. Two patients refused to undergo further procedures. Complications encountered were difficult nail removal in three cases, broken nail in two cases, and bent nail in one case. Recurrence of infection was observed in two patients. Average period of follow-up was 13 months.ConclusionAntibiotic cement impregnated nailing is a simple, economical and effective single stage procedure for the management of infected nonunion of tibia. It is advantageous over external fixators, as it eliminates the complications of external fixators and has good patient compliance. The method utilizes existing easily available instrumentation and materials and is technically less demanding, and therefore can be performed at any general orthopaedic center.

Preliminary outcomes of proximal femur megaspacers

“…Antibiotic-coated hip spacer for periprosthetic infection treatment are described in detail in the literature [2] , [4] , [5] , [7] , [8] , [10] , [12] , [20] , [21] , as well as the use of antibiotic-coated intramedullary nails for infected long bones fractures or infected nonunions [13] , [14] , [16] , [17] , [22] , [23] . However, there are few reports describing therapeutic options applied to cases in which a deficit of proximal bone stock of the femur coexist with a femur shaft defect (fracture or nonunion) in the context of an infection; most of them were case reports about a single and unique salvage technique.…”

“…One of them is the implantation of the antibiotic cement-coated intramedullary nails used for the treatment of osteomyelitis associated with fractures or infected nonunions of long bones [13] , [14] , [17] . This technique allows intramedullary debridement (through reaming, intramedullary irrigation, and debris removal), provides both fracture stability and high local concentration of antibiotics, and restores limb function by maintaining joint mobility and allowing weight-bearing ambulation.…”

Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

“…Thonse and Conway reported an 85% rate of infection control [ 6 ]. Bhatia et al reported a 95% rate of infection eradication [ 37 ]. Similar results proved that the bone cement nail has a satisfactory infection control effect [ 38 ].…”

“…In terms of bone union, there are different results in different studies. Bhatia et al reported a 60% rate of bone union without an additional procedure [ 37 ]. Zheng and Hang reported a 22% rate of union [ 19 ].…”

Salvaging Chronic Nonunion of Femoral Neck and Infected Nonunion of Ipsilateral Femoral Shaft Fracture Using Intramedullary Antibiotic Cement Spacer and External Fixator Alone

“…These procedures are cumbersome and may take several months to regenerate bone. Such infected non-unions should preferably be managed with staged surgeries where the intramedullary and local infection is controlled with local and intramedullary antibiotic cement spacers and temporary stabilization with an external fixator [ 4 ]. Additionally, prolonged antibiotic therapy is required according to the culture reports.…”