Use of antibiotic cement rod to treat intramedullary infection after nailing: preliminary study in 19 patients

Abstract

The treatment of intramedullary infections after nailing usually includes removal of the nail, debridement, and, in some cases, insertion of antibiotic-impregnated cement beads. We use this self-made antibiotic cement rod to treat intramedullary infections. Compared with the beads, it provides some limited mechanical support and can be preserved in the canal for a long time. We reviewed 19 infected patients who underwent removal of the nails, excision of sinus tracks, debridement of the canal and insertion of the rods. No recurrent infection occurred in 18 cases and 11 cases achieved bone healing, 6 cases achieved partial union. One patient had nonunion and one patient underwent amputation because of severe primary trauma and long-term infection. The rod was removed between 35 and 123 days after implantation. We conclude that the antibiotic cement rods could be a relatively effective, simple and inexpensive method of treating intramedullary infections after nailing.

An Improved Technique for Removing Intramedullary Antibiotic Beads in Osteomyelitis of the Tibial Shaft

“…As an alternative to the use of cement beads, some reports have suggested the use of an antibiotic-impregnated cement rod, but this has, in some cases, been accompanied by breakage of the rod, and in other cases the diameter of rod has also been too large for insertion into the intramedullary cavity. In such cases the broken rod has had to be extracted by bone fenestration [4,5]. In the cases of our patients, the hook-shaped intramedullary guidewire used for retrieving cement beads from the intramedullary cavity was passed easily into the narrow space between the wall of the cavity and the beads, despite the ingrowth of granulation tissue into the cavity.…”

“…In this setting the insertion into the intramedullary cavity of antibiotic-impregnated cement beads to sterilize the canal is the preferred method of local delivery of antibiotics to the site of infection [3,7,9]. However, the removal of such beads from the cavity may be compromised by the ingrowth of granulation tissue between the beads [4,5]. As an alternative to the use of cement beads, some reports have suggested the use of an antibiotic-impregnated cement rod, but this has, in some cases, been accompanied by breakage of the rod, and in other cases the diameter of rod has also been too large for insertion into the intramedullary cavity.…”

“…In most cases, removal of an implanted chain of such antibiotic-impregnated beads is required several weeks after its insertion, when the infection has been controlled [3]. However, breakage of the chain sometimes occurs during its attempted extraction, causing difficulty in the removal of any remaining beads [3][4][5]. The present report describes a novel method of extracting antibioticimpregnated beads remaining in the intramedullary cavity without the need for invasive procedures, such as bone fenestrations.…”

A simple method for fashioning an antibiotic impregnated cemented rod for intramedullary placement in infected non-union of long bones

“…Several methods [6][7][8][9] of local antibiotic delivery system using PMMA are being commonly used which includes hand fashioned or commercially available PMMA beads, 10 PMMA rods [11][12][13] and PMMA coated nails. [1][2][3][4] None of these methods provide adequate stability and necessitates secondary procedure for stability at the fracture site in form of intramedullary interlocking nailing, cephalomedullary nailing or LCP with or without autogenous bone grafting.…”

Infected nonunions of long bones of the upper extremity: staged reconstruction using polymethylmethacrylate and bone graft impregnated with antibiotics

“…Polymethylmethacrylate (PMMA) and cancellous bone graft are effective local antibiotic delivery systems to prevent and combat infections [2,[4][5][6]. Actual available evidence on the operative management of infected nonunions of the long bones suggests that staged reconstruction (debridement, antibiotic beads and planned secondary fixation) allows achieving union in 93-100% of cases and persistence of infection is present only in 0-18% of cases, significantly better that one-stage strategies and two-stage strategies without the use of cement beads [2].…”