Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review.

Daniele De Meo,Daniele De Meo,Luisa Petriello,Pietro Persiani,Ciro Villani,Luisa Petriello,Ciro Villani,Federico M Cannari

doi:10.3390/molecules25225471

Daniele De Meo, Daniele De Meo + Show 6 more

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https://doi.org/10.3390/molecules25225471

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Abstract

The incidence of a fracture-related infection (FRI) can reach 30% of open tibia fractures (OTF). The use of antibiotic-coated implants is one of the newest strategies to reduce the risk of infection in orthopedic surgery. The aim of this study was to investigate the efficacy and safety of a gentamicin-coated tibia nail in primary fracture fixation (FF) and revision surgery (RS) of nonunion cases in terms of FRI incidence. We conducted a systematic review according to the PRISMA checklist on Pub-Med, Cochrane, and EMBASE. Of the 32 studies, 8 were included, for a total of 203 patients treated: 114 were FF cases (63% open fractures) and 89 were RS cases, of which 43% were infected nonunion. In the FF group, four FRI were found (3.8%): three OTF (Gustilo-Anderson III) and one closed fracture; bone healing was achieved in 94% of these cases. There were four relapses of infection and one new onset in the RS group; bone healing occurred in 88% of these cases. No side effects were found. There were no significant differences in terms of FRI, nonunion, and healing between the two groups. Gentamicin-coated tibia nail is an effective therapeutic option in the prophylaxis of high-risk fracture infections and in complex nonunion cases.

Highlights

Tibia shaft fractures are the most common long-bone fractures among adults and children [1].They have a deep socio-economic impact, accounting for approximately 26 fractures per 100,000 and569,000 hospital days per year [1,2]
Incidence increases in young adults who suffer high-energy trauma or in elderly people who suffer low-energy trauma directed towards poor quality bone tissue due to osteoporosis [3]
A mention should be made of elderly people, as a substantial difference in the fracture pattern can be observed; the rate of open fractures in these patients can be as high as 30%, of which 10% are nonunion and 17% are malunion [6]

Summary

Introduction

Tibia shaft fractures are the most common long-bone fractures among adults and children [1].They have a deep socio-economic impact, accounting for approximately 26 fractures per 100,000 and569,000 hospital days per year [1,2]. Tibia shaft fractures are the most common long-bone fractures among adults and children [1]. They have a deep socio-economic impact, accounting for approximately 26 fractures per 100,000 and. Incidence increases in young adults who suffer high-energy trauma or in elderly people who suffer low-energy trauma directed towards poor quality bone tissue due to osteoporosis [3]. A mention should be made of elderly people, as a substantial difference in the fracture pattern can be observed; the rate of open fractures in these patients can be as high as 30%, of which 10% are nonunion and 17% are malunion [6]. Health care costs can Molecules 2020, 25, 5471; doi:10.3390/molecules25225471 www.mdpi.com/journal/molecules

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