The Antibiotic Nail in the Treatment of Long Bone Infection

Koury, Kenneth L.; Hwang, John S.; Sirkin, Michael

doi:10.1016/j.ocl.2016.12.006

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…There is no consensus about FRI cure, and there are no definitive parameters validated for this situation. Clinically, we can only discuss controlled infection, and most series use clinical evaluation, acute phase markers and complementary tests to evaluate a controlled infection 31. In our series, we chose these data to define a controlled infection.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review, there were multiple complications related to the hardware when managing infections with custom-made nails, and a series with a report of 20% PMMA mantle break. 31. To prevent these complications, an over-reaming of a minimum of 2 mm has been proposed 43, but this requires the use of small nails or aggressive reaming to use a wider nail.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the use of non-industrial devices, manually generated, is not reproducible in most cases, and the PMMA mantle and antibiotic elution can be different between implants constructed in the same manner 30. Third, some authors have created antibiotic-laden PMMA-covered locking custom-made nails 22, but not all described techniques provide a locking nail to achieve stability; some only act as spacers 31, 32. Finally, the mantle of PMMA could be removed easily during insertion of the custom-made implant, complicating future hardware extraction and generating free PMMA pieces/particles in the medullary canal (Figure 1 A) 31.…”

Section: Introductionmentioning

confidence: 99%

“…Third, some authors have created antibiotic-laden PMMA-covered locking custom-made nails 22, but not all described techniques provide a locking nail to achieve stability; some only act as spacers 31, 32. Finally, the mantle of PMMA could be removed easily during insertion of the custom-made implant, complicating future hardware extraction and generating free PMMA pieces/particles in the medullary canal (Figure 1 A) 31. Added to these inconveniences, we must include the waste of time dedicated to the fabrication of the nail, which increases surgical time and costs.…”

Section: Introductionmentioning

confidence: 99%

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

Jorge-Mora

Amhaz-Escanlar

Fernandez-Pose³

et al. 2019

J. Bone Joint Infect.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Jorge-Mora

Amhaz-Escanlar

Fernandez-Pose³

et al. 2019

J. Bone Joint Infect.

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“…El tiempo promedio de mantenimiento del clavo fue de tres meses (rango [1][2][3][4][5][6][7][8][9][10][11][12][13]. No se observaron diferencias significativas entre la mediana del intervalo de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el del resto de los gérmenes (48 días [RIC 45-75] vs. 73.5 días [RIC 56-149]; p = 0,2002 Mann-Whitney).…”

Section: Resultsunclassified

Clavo endomedular recubierto con antibiótico para controlar la infección en una seudoartrosis infectada de húmero. [Antibiotic cement rod to control infection in infected humerus nonunion]

Brandariz

Bennice

Boretto

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH).Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses.Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos <2 cm (7 pacientes) y grupo con defectos ≥2 cm (4 pacientes). No se observaron diferencias significativas entre la mediana de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el de otros gérmenes (48 días [RIC 45-75] vs. 73,5 días [RIC 56-149], p = 0,2002 Mann-Whitney), ni en la proporción del tamaño del defecto óseo según el desarrollo de SARM o de otro germen (60% vs. 17%, p = 0,242 Fisher). Todos los cultivos fueron negativos y se logró la consolidación del foco fracturario, sin recurrencia de la infección.Conclusiones: El CERA es una buena opción terapéutica en el primer tiempo quirúrgico para un paciente con SIH. Se pudo controlar la infección, lo que permitió la reconstrucción secundaria de la seudoartrosis. AbstractObjetive: To evaluate the efficiency of the antibiotic cement rod (ACR) in the eradication of infection in infected humerusnonunion (IHN).Material and methods: We included 11 patients with IHN with a mean age of 48 years. The time between fracture-surgery was 25 months. The ACR was impregnated with vancomycin in 9 of de 11 cases. Follow-up was 54 months.Results: Methicillinresistant staphylococcus aureus (MRSA) was isolated in 5 of cases. All patients received antibiotics systemically for 7 weeks. Vancomycin was the most commonly used antibiotic. Time between ACR and reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual space of the nonunion was measured with dichotomous variables and classified into two groups: group 1, < 2 cm (7 patients) and group 2, ≥2 cm (4 patients). No significant differences were observed between the number of days in which the ACR was placed and the development of the SAMR as compared to other germs [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p= 0.2002 Mann Whitney]. Nor were differences observed in the size of the defect in those who developed MRS or any other germ (p=0.242 Fisher). Reconstruction was performed with different techniques. Laboratory parameters were normal, cultures were negative. Fractures could be consolidated without infection recurrence.Conclusions: ACR is a good treatment option for a patient with an INH. The infection could be controlled in all of the cases, which allowed the secondary reconstruction of the nonunion

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