Intramedullary Nailing with an Absorbable Antibiotic Carrier (INaac): A Simple Technique Using Standard Implants

Abstract

Introduction: Intramedullary nailing has revolutionized the treatment of long bone fractures and non-unions. However, there is rightly concern about the use of nails when there is established infection or when the risk of subsequent infection is high. Recently, this concern has been partly addressed by the introduction of intramedullary nails combined with an antibacterial coating. Various methods have been reported with some success but also with some drawbacks. Methods: This paper reports a simple technique for coating an intramedullary nail with an absorbable antibiotic carrier. The carrier is injected directly into the reamed medullary canal, coating the nail during nail passage and delivering high levels of antibiotics at the nail-bone interface. Results: This technique was found to be easy to apply. It allowed use of standard fracture implants without the need for downsizing of the nail diameter. There is no need for nail removal or exchange after initial treatment of the infection. Conclusion: This simple technique combines the benefits of a bioabsorbable antibiotic carrier with standard fracture nails to prevent or treat long bone infections. It avoids the problems of PMMA coated nails or the need for specialist implants.