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

Abstract

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.

Antibiotic coated nails: Rationale, development, indications and outcomes

“…While the literature on antibiotic-coated nails is limited, there have been some studies and case series with overall positive results. [21][22][23][32][33][34][35][36][37][38][39][40] One of the first published case-series from 2007 showed control of infection in 95% of patients with infected nonunions and segmental bone-defects by using custom made antibiotic rods. 23 Since then, a number of important publications have been released, which cover both commercially available and custom-made antibiotic nails/ rods.…”

Antibiotic impregnated cement coated intramedullary nail (ACCIN) using bronchoscopy tubing: technical tips, case series and a review of the literature

“…The use of antibiotic cement coated interlocking nails (ACCINs) for infected delayed or non-unions of tibial shaft fractures has been established as a safe and practical method of eradicating infection while simultaneously providing stability [ 1 – 4 ]. ACCIN can be performed simultaneously with other management of this challenging condition, such as surgical debridement, adequate soft tissue coverage, systemic administration of specific antimicrobials and/or dead space management [ 5 ]. Previous methods of treatment such as first removing infected hardware, eradicating infection, followed by definitive fixation months later once infection has been cleared, present challenges such as prolonged periods of non-weight bearing which can be severely functionally limiting for the patient.…”