Prospective study of infected non-union of long bones treated by Antibiotic impregnated intramedullary nailing

Abstract

Background: In a era of high velocity injuries, compound fractures are very common in orthopaedic practice n despite of preventive measures taken pre operatively and post operatively, infected non unions still common and they pose real challenge to the treating surgeon and makes the patient debilitating. In infected non-union case, the preference has to be given to eradication of the infection before aiming to achieve fracture union. Many methods of treatment have been described in the past including ilizarov fixator and Antibiotic cement impregnated intramedullary nailing(ACIIMN). Sustained and gradual release of heat stable antibiotics which are mixed with the bone cement at a high concentration and coating it on Intramedullary nail(ACIIMN) has gained popularity among the techniques used to treat infected non unions. Our study is aimed at summarizing our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIMN) for control of infection in cases of infected non-union. This is a report of series of 27 infected non union cases, both femur and tibia which were treated by Antibiotic cement impregnated intramedullary nailing(ACIIMN) in our institute. Aims and objectives: To evaluate the outcome of treatment of infected nonunions of long bones treated by Antibiotic cement impregnated intramedullary nailing(ACIIMN). Materials and Methods: Our’s is prospective study involving 27 cases of infected nonunions of long bones treated by Antibiotic cement impregnated intramedullary nailing(ACIIMN) at our institute from 2012- 2015. The outcome of procedure was evaluated with regards to infection control, deformity, bony union and limb length discrepancy etc. Results: Infection was eradicated in 23 cases with ACIIN and the fractures united. In 4 cases, though the infection was controlled with ACIIN, they required subsequent procedures like exchange nailing with bone grafting to achieve bony union. Conclusion: Antibiotic cement impregnated nailing is a very simple yet economical and very effective procedure than the other methods in treatment of infected non-unions of long bones. Keywords: long bones, Infected non-union, antibiotic cement impregnated intramedullary nail