The treatment of early and delayed infection of intramedullary nails of lower limb

Abstract

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intra-medullary nail fixation. Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to Au-gust 2017 were retrospectively analyzed. There were 18 males and 4 females aged from 20 to 72 years old, with an average age of 46.8 years. 14 cases were tibias and 8 cases were femurs. In the early infection group, 6 cases showed swelling, heat and pain in the affected area with drainage and pus. In the late infection group, 12 cases showed sinus formation and 4 cases showed no sinus tract. According to whether the infection occurred within six weeks, it was divided into early infection and delayed infection groups. Of 6 patients in early infection group, there was 1 case of septic shock which underwent removal of intramedullary nails, debridement and antibiotic bone cement stick implantation. 5 cases were retained intramedullary nail and underwent local debride-ment treatment. Late infection occurred in 16 patients. One patient with tibia infection was given partial dressing to heal the frac-ture. Then the intramedullary nail was removed and intramedullary debridement was performed. Two patients with poor general condition, the intramedullary nails were removed and debridement was performed. Calcium sulphate cement was implanted and fixed with external fixation. The remaining 13 cases were treated with debridement and antibiotic cement stick implantation. We compared the differences between early and late infections of internal fixation, infection control, fracture healing, and secondary fracture fixation. Results Of the 6 patients with early infection, 1 patient with septic shock removed intramedullary nails to con-trol infection. After infection controlled, the fracture was treated with intramedullary nailing. Of the 5 patients with retained intra-medullary nails, 2 patients’ infection were controlled and 3 were uncontrolled. After removal of the intramedullary nails the infec-tion was control. The success rate of retaining intramedullary nails was 33.3% (2/6). Late infection occurred in 16 cases and infec-tion was all controlled. The fractures healed in 22 patients. The fracture healing time of 6 patients with early infection was 2-6 months, with an average of 3.67±2.08 months. The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months. Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may at-tempt debridement therapy with retained intramedullary nails, but the failure rate is high. If the intramedullary nail fails to remain, follow the treatment of patients with delayed bone infection. For patients with delayed bone infection, because the fracture has not yet healed, thorough debridement is used after the removal of internal fixation, then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation. For the second phase, we may choose plate, intramedullary nail or external fixation to fix the fractures according to the soft tissue condition. All of the fixation methods could provide good fracture healing. Key words: Femur; Tibia; Infection; Fracture fixation, intramedullary