Antibiotic Nail Research Articles

Investigation of Coupling Effect for Adjacent Orthopedic Implants on MRI Radio-Frequency Heating

This paper investigates the mechanism of radio-frequency (RF) heating that occurs when two adjacent orthopedic implants are present together under magnetic resonance imaging (MRI) at 1.5 Tesla and 3.0 Tesla. When a patient has multiple implants close to each other, interactions between the implants may increase RF heating. Typical generic interlocking plate and antibiotic nail implants are adopted as examples. To analyze the effect of adjacent implants, the amplitude and direction of incident and scattering vector electric fields at the hot spot position are calculated and extracted using numerical simulation based on Huygens principle. It is shown that a strong coupling effect occurs due to the existence of both the incident field and a strong scattering field. Huygens principle can be used to obtain the first and second order scattering fields generated between implants. If the first- and second-order electric field terms are summed within a certain region, the RF-induced heating of this dual-implant system increases.

Antibiotic cement nails manufactured with threaded rods or cannulated intramedullary nails are better than those made with guidewires and do not debond.

The purpose of this study was to comparatively evaluate cement debonding at the time of removal of antibiotic cemented coated nails (ABNs) with cores made with a guidewire ($120), a regular intramedullary nail ($1100) or a threaded rod from a circular frame external fixator set ($60). A retrospective study was performed on 32 ABNs that had been implanted for long bone infections after intramedullary nailing. All ABNs were manufactured intraoperatively by the treating surgeon using 2 grams of vancomycin and single package of Tobramycin Simplex Cement (Stryker, Kalamazoo, MI). The powder, antibiotics, and polymer were mixed and then injected into an ABN cement mold (Bonesetter Holdings USA). Debonding was assessed at time of removal by the operating surgeon. Rates of cement debonding between the 3 groups were statistically compared. Debonding occurred in 0/12 of the cement nails manufactured with an intramedullary nail, 0/7 threaded rod ABNs, and 6/13 guidewire ABNs. There was a significant difference in the rate of debonding between the 3 groups (P < 0.01). Removal of the remnant cement was accomplished with thin osteotomes, long pituitary rongeurs, or reamers. The canal was visualized using an arthroscope to ensure complete removal of the cement. ABNs fabricated with standard intramedullary nails or threaded rods did not lead to any debonding. Debonding of the cement from the inner core of an antibiotic nail often requires significant effort to remove the remnant cement. Given that threaded rods are often cheaper than guidewires, we recommend that ABNs be fabricated with either threaded rods or interlocking nails, but not guidewires, depending on the level of stability required.

Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones

Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.

Short term results with the use of PLA antibiotic coated nail in open tibia fractures: A prospective study

BackgroundAntibiotic impregnated cement coated nails have been described in literature with promising success rates. However, they need removal at a later stage. This study focuses on use of a PLA-precoated antibiotic nail that stops eluting antibiotic after a while and can be retained later as it behaves as a standard interlocking nail in the long run. PurposeTo study if PLA (polylactic acid) -antibiotic coated nails reduces infection and non-union rates and improve the functional outcome in open tibial shaft fracture cases. Materials and methodsIn this prospective cohort study, we included 54 patients with open tibia shaft fractures treated with wound debridement and internal fixation using a reamed PLA (polylactic acid)-antibiotic coated nail (CE-certified, OSSIPRO, MatrixTM). ResultsForty patients with a Grade 2 and ten with grade 3A open tibial fracture, according to the Gustilo-Anderson classification, completed a minimum of six months of follow-up and were included in the analysis. At the final follow-up, four patients (all with grade 3A fracture) had an active infection, 10 (four of grade 2 and six of grade 3A) had non-union, the mean physical component score (SF-36 score) was 55.2 ± 20.10 (grade 2; 58.95 ± 9.99, grade 3A; 40.19 ± 16.37, P value 0.002), and the mean mental component score (SF-36 score) was 54.96 ± 23.5 (grade 2; 57.96 ± 16.63, grade 3A; 42.94 ± 23.75, P value 0.04). Furthermore, Multivariate analysis showed age and grade of fracture to be independently related to the development of infection and non-union. ConclusionAlthough the use PLA-antibiotic coated nail looks promising, short-term results have revealed no additional benefit in terms of reduced infection rates, improved union rates or functional outcomes. Large multicentric randomized controlled trials and a long term follow up are advised to further explore the role of PLA coated antibiotic nails in open tibial fractures.

Functional and radiological outcomes of primary ring fixator versus antibiotic nail in open tibial diaphyseal fractures: A prospective study

Management of open fractures of tibia is still a matter of debate due to high incidence of infections. Traditionally external fixators have been advocated in managing open tibial fractures. Due to limited efficacy of systemic antibiotics, recently antibiotic coated intramedullary interlocking nails have been developed for the management of open tibia fractures. Therefore, we conducted this prospective randomized study to compare the functional and radiological outcomes of primary ring fixator versus antibiotic coated nail in open diaphyseal tibial fractures. The study included 32 patients with Gustilo-Anderson type II and type IIIA fractures of tibial diaphysis. Out of them 16 patients were managed with Ring External Fixator (Group I) and 16 were managed with OssiproÒ gentamicin intramedullary interlocking tibial nail (Group II). The radiological and functional outcomes were assessed at final follow-up according to and SMFA criteria. Statistical analysis of the data was performed using IBM SPSS statistics 2.0 software. Chi square test and independent student t-test were used and a P value <0.05 was considered statistically significant RESULTS: Union was achieved in 15 patients (93.8%) in group I and 13 patients (81.2%) in group II. Pin tract infection was seen in 6 patients (37.5%) in group I, whereas infection was present in 2 patients (12.5%) in group II. Bone results were excellent in 13 patients (81.3%), good in 2 patients (12.5%), poor in one patient (6.3%). In group II, bone results were excellent in 12 patients (75%), good in one patient (6.2%), poor in 3 patients (18.8%). At 1 year of final follow up, mean SMFA score was 24.41±5.87 in group I, whereas mean SMFA score was 23.703±8.02 in group II. Ring fixator as well as antibiotic coated tibial interlocking nail achieved comparable rates of union in the present study. Complication rates were similar in both the groups and the functional and radiological outcomes were comparable in both groups. Results of this study indicate that although ring fixation is an established option for management of open tibial fractures, antibiotic-coated intramedullary nail is also a reliable option in open Grade II and grade IIIA injuries. Level II.

Outcomes of Various Antibiotic Cement-Coated Intramedullary Implants on the Treatment of Long Bone Septic Nonunion.

To determine the effectiveness of various types of antibiotic-coated intramedullary implants in the treatment of septic long bone nonunion. Retrospective chart review. Level 1 trauma center. Forty-one patients with septic long bone nonunion treated with an antibiotic cement-coated intramedullary implant. Surgical debridement and placement of a type of antibiotic-coated intramedullary implant. Union and need for reoperation. At an average 27-month follow-up (6-104), 27 patients (66%) had a modified radiographic union score of the tibia of 11.5 or greater, 12 patients (29%) a score lower than 11.5, and 2 patients (5%) underwent subsequent amputation. Six patients underwent no further surgical procedures after the index operation. Patients treated with a rigid, locked antibiotic nail achieved earlier weight-bearing (P = 0.001), less frequently required autograft (P = 0.005), and underwent fewer subsequent procedures (average 0.38 vs. 3.60, P = 0.004) than those treated with flexible core antibiotic rods. Antibiotic-coated intramedullary implants are successful in the treatment of septic nonunions in long bones. In our cohort, rigid, statically locked nails allowed faster rehabilitation, decreased the need for autograft, and decreased the number of additional surgical procedures. Further study is needed to confirm these findings. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series.

Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic nails have been shown to play a role in the treatment of open fractures in terms of fracture healing and lower risk of infection. We retrospectively analyzed our results, from January 2016 to March 2020, with the use of coated nails in the treatment of open tibial fractures, evaluating the rates of infection and fracture healing as primary outcomes and the rate of reoperations, time from trauma to nailing and hospital stay as secondary outcomes. Thirty-eight patients treated with coated nail (ETN ProtectTM, Synthes) were included in the study. Minimum follow-up was of 18 months. Thirty-four of 38 patients achieved bone union and 2 patients underwent septic non-union. In our series, no systemic toxicity or local hypersensitivity to antibiotics were recorded. From this study, use of antibiotic-coated nails appears to be a valid and safe option for treatment of open tibial fractures and prevention of implant-related infections, particularly in tibial fractures with severe soft tissue exposure and impairment.

English

BACKGROUND Infected non-union is a complex, debilitating and challenging disorder affecting orthopaedic surgeon and patient in terms of cost and time.1 Antibiotic impregnated nail has been a cheap and effective method used for treatment of infected nonunion. Factors that may lead to infected non-union are many.2,3 High local concentrations of antibiotics with minimal systemic levels and without systemic side effects make local antibiotic therapy a very useful technique in treating infected non-union. 4 Buchholz and Engelbrecht were the first to use antibiotic impregnated cement.5 Major advantage of using antibiotic impregnated cement is, it provides high concentration of antibiotics locally with less systemic side effects.6 The purpose of this study was to determine the functional outcome of antibiotic impregnated nail in treatment of infected non-union of femur and tibia. Antibiotic cement impregnated intra-medullary nail can provide stability, help in control of infection,7 is easy to remove, and also provides all the advantages of the cement beads.8,9 METHODS This prospective study was done on 25 cases at Government Medical College Thrissur from 01 September 2016 to 01 April 2018. Functional results were evaluated with regard to control of infection, bony union, deformity, limb leg discrepancy and complications (both intra and post-operative complications). RESULTS Most of the cases had type 2 open injury initially, accounting for 49 %. Staphylococcus aureus was reported in 56 % of cases. Infection control was achieved in 23 cases. Bony union was visualised in 18 cases, remaining 5 cases united following bone grafting. In 2 cases there was no control of infection and no bony union was achieved, later antibiotic nail removal and Ilizarov fixation was planned. Bone grafting was done in 10 cases. CONCLUSIONS Antibiotic impregnated cement nailing is a simple, economical and very effective procedure with less complication and shorter duration of treatment when compared with other conventional procedures. KEYWORDS Infected Non-Union, Long Bones, Antibiotic Impregnated Cement Nail

Revision proximal femoral antibiotic nailing for non-union of neck and shaft of femur fracture with infected implant in situ and discharging sinuses: A case report

Introduction: Chronic osteomyelitis of femur with implant in-situ and discharging sinuses is conventionally treated stepwise, but our study is more economical and effective single step procedure of fracture fixation by using antibiotic intramedullary nails, and antibiotic beads done in same sitting. Aim: To assess the duration of eradication of infections. and to determine duration of bony union for cases treated secondarily with antibiotic intramedullary nail. Material and Methods: This is the case report of chronic osteomyelitis of femur with implant in-situ with discharging sinuses. The case was primarily treated immediately after trauma with plating and screw fixation now presented with infection and discharging sinuses. Culture and sensitivity were done, allergy for the sensitive antibiotics ruled out. Postoperatively it was followed up for 12 months. Results: Infection was fully controlled and bony union was achieved. Discussion: Antibiotic nailing is comparatively more economical and effective single stage procedure for management of infected femur fracture with non-union with implant in-situ with discharging sinuses. This method delivers high concentration of antibiotic at local site without any systemic toxicity. It has better compliance compared to the conventional way of management.

Outcomes of Primary Tibiotalocalcaneal Nailing for Complicated Diabetic Ankle Fractures

Category:Trauma, Ankle, Ankle ArthritisIntroduction/Purpose:Ankle fractures in complicated diabetic patients (i.e. presence of neuropathy, nephropathy, or peripheral vascular disease) have significantly increased rates of complications with markedly worse functional outcomes. Current management advocates for operative intervention due to high rates of fracture reduction loss and Charcot arthropathy in those treated nonoperatively. Tibiotalocalcaneal (TTC) nails have been reported in the literature as a salvage option when initial ankle stabilization has failed. We hypothesize that the minimally invasive, robust construct that primary TTC fixation with an intramedullary nail offers will result in high rates of limb salvage, acceptable rates of complications, and nominal loss of function.Thus, the purpose of this study was to evaluate the outcomes of primary TTC intramedullary nailing for definitive treatment of neuropathic ankle fractures.Methods:This was an IRB approved retrospective study of 27 complicated diabetic patients who underwent TTC nailing of their ankle fracture as a primary treatment without formal joint preparation. The study was undertaken at an urban Level 1 trauma center. Complicated diabetes was defined as having one or more of the following formal diagnoses: neuropathy (20 patients), nephropathy (4), PVD (3). Mean clinical follow up was 888 days (range 21-2843 days). Patients were screened for associated risk factors such as open fracture, neuropathy, nicotine and alcohol abuse, obesity and elevated Hba1c. Data was also collected on surgical complications such as superficial and deep infection, wound dehiscence, amputation, revision fixation, hardware failure, malunion, nonunion. Outcomes were measured in length of hospital stay, loss of ambulatory level, and time to death.Results:The mean age was 66 (32-92) years with an average BMI of 38 (21-68). Six of 27 fractures were open and 20 of 27 patients were neuropathic. Mean hemoglobin A1C was 7.4 (5.5-13). Average hospital stay was 6 days (0-22). The average patient was fully weight bearing at 6 weeks (1-17). Two patients underwent removal of hardware, due to pain and proximal screw failure respectively. One patient required formal arthrodesis. There were no malunions, symptomatic nonunions, or instances of Charcot arthropathy. Two patients underwent repeat debridement for infection, resulting in antibiotic nail placement and above knee amputation respectively. A total of eight patients had died by final follow up (mean 1048 days) from index procedure. Overall, mean ambulatory status was maintained.Conclusion:Primary tibiotalocalcaneal nailing is a viable alternative to previously described methods of fixation of complicated diabetic ankle fractures. With high limb salvage rates, early weight bearing, maintained ambulatory status and low rates of return to the operating room, our technique can be considered an applicable approach to increase overall survivability of threatened limbs and lives with acceptably low complications.

Role of antibiotic-impregnated cement intramedullary nail in infected nonunion of long bone diaphyseal fractures

Introduction: Infected nonunion of long bones is a chronic and debilitating disorder to manage. The problems in treating them are infection, instability, and deformity. This study aims to evaluate the effectiveness of antibiotic-impregnated intramedullary nail as a management for infected nonunion of long bones. Materials and Methods: A total of 12 cases of infected nonunion of long bones (10 – tibia and 2 – femur) without bone loss and age group of more than 18 years are treated using antibiotic cement-coated k-nail. Antibiotics used are vancomycin 4 g and clindamycin 2 g. The average duration of retention of antibiotic nail was 24 weeks. Results: At follow-up, infection was controlled in 90% of cases. Bony union achieved in 8 out of 12 cases (66%). Rest 4 cases required further additional procedures. Recurrence of infection occurred in two cases. Conclusions: This is a very effective and economical with better patient compliance. This method achieves infection control, promotes bone union, and mechanical stability.

Are antibiotic nails effective in the treatment of infected tibial fractures?

BackgroundAntibiotic-impregnated cement nails are used to treat postoperative deep infections after primary intramedullary nail insertion for the treatment of tibial fractures. Few data exist regarding the efficacy of this treatment strategy. We hypothesized that such treatment with antibiotic nails results in a high rate of infection clearance at intermediate follow-up. MethodsWe conducted a retrospective review at our Level I trauma center. Patients who received intramedullary nails to stabilize tibial fractures (from 2000 to 2011) and subsequently required antibiotic nails to treat deep postoperative infection (n=55) were considered for study inclusion. Patients with less than 6 months of follow-up were excluded, leaving 41 patients in the study group (average age, 41 years; average follow-up, 20 months). ResultsThirty-one patients (76%) had no evidence of infection after treatment. The 10 patients for whom treatment failed were shown to have infection within the first 6 months. Two experienced persistent infection after antibiotic nail removal, necessitating massive débridement and ring fixator placement. Four patients underwent repeat antibiotic nail insertion after persistent infection. Three infections resulted in eventual above-knee amputations, and one chronic infection resulted in the need for multiple débridement and saucerization procedures. No complications associated with use of the antibiotic nails were observed. ConclusionThe use of antibiotic nails for treatment of tibial infections seems to be a reasonable option, clearing 76% of infections at the 6-month time frame. Further investigation is needed to compare this treatment algorithm with other strategies, such as antibiotic treatment without nail removal and massive débridement with ring fixator placement.

Custom-made antibiotic cement nails: A comparative study of different fabrication techniques

IntroductionThe management of intramedullary long bone infections remains a challenge. Placement of antibiotic cement nails is a useful adjuvant to the antibiotic treatment of osteomyelitis. However, fabrication of antibiotic cement nails can be arduous. The purpose of this article is to introduce an easy and reproducible technique for the fabrication of antibiotics cement nails. Materials and methodsWe compared the time required to peel the chest tube off the 6 antibiotic cement nail using 2 different cement-cooling techniques and the addition of mineral oil in the chest tube. Additionally, we evaluated the optimal time to cut the chest tube (before and after cement hardening), consistency of nail's diameter, and the roughness of its surface. Cooling and peeling times were measured and failure was defined as a working time (from cement mixing to have a usable antibiotic cement nail) that exceeded 1h. ResultsWhen the antibiotic cement nail was left to cool by convection (i.e. air-cooling), we failed to peel the plastic off the cement nail. When the chest tube was cut after conductive cooling (i.e. cold water-cooled), the cooling time was 10min and the peeling time was 30min without the use of mineral oil; the addition of mineral oil reduced peeling time to 7.5min. Following peeling, residual adherent plastic pieces were found along the entire surface of the nail when no mineral oil was used. This was rarely seen when mineral oil was utilized to coat the inner layer of the chest tube. ConclusionConductively cooling of the cement nail (in cold water) and pre-lubricating the chest tube with mineral oil are 2 tricks that render fabrication of antibiotic nail more efficient, reliable, and practical.

Management of Infection After Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes

Implant related sepsis is a relatively unusual complication of intra-medullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of infection following IM nailing of long bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria.Only a few prospective studies exist to report on the management of infection following IM nailing of long-bone fractures. In general, stage I (early) infections only require antibiotic administration with/without debridement. Stage II (delayed) infections can be successfully treated with debridement, IM reaming, antibiotic nails, and administration of antibiotics. Infected non-unions are best treated with exchange nailing, antibiotic administration and when infection has been eradicated with graft implantation if it is needed. Debridement, exchange nailing and systemic administration of antibiotics is the best indication for stage III (late) infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.

Management of intramedullary lower extremity osteomyelitis using the RIA system

Introduction Reaming of the canal is an important step in the debridement phase of treating intramedullary infections. Numerous techniques of radical canal debridement have been successfully reported. The use of the Reamer-Irrigation-Aspiration system (RIA-Synthes) is currently expanding to include this clinical scenario. Materials and methods Prospective collection of data related to infected cases treated with the use of the RIA in a tertiary referral centre referring to a 3 year period. Peri-operative details, microbiology results, and follow-up outcome over a minimum period of 12 months post-surgery are reported. Results Twenty patients (13 men), with average age 44.8 years (18–75), suffering from 7 tibial and 13 femoral infections represent the study cohort. There were 19 surgical-site-infections, and 1 spontaneous haematogenous infection in non-previously operated extremity. The canal was stabilised using an antibiotic-loaded-cement-nail in 18 cases. The antibiotic nail was subsequently removed after 6–8 weeks. The most commonly isolated organism was staphylococcus aureus. There were followed-up regularly (2,6, 12 weeks, and then at 6 months and 12, 24, 36 months). At 6 months follow up (range 12–43 months) no recurrence was observed. Two patients died during the course of the study. One patient at the day after surgery due to septic shock, and another one at 2 years due to irrelevant causation. Another patient had a below knee amputation after debriding of the canal for pan-medullary osteomyelitis. However, there was no recurrence in the stump at the latest follow up after 1 year. Conclusion The usage of this new device shows promising results in the treatment of intramedullary osteomyelitis. Reaming under simultaneous irrigation and suction appears to be an effective and safe alternative for debridement of the intra medullary infections of femur and tibia. Long term follow up is essential, as post traumatic osteomyelitis can occur at any time after surgical treatment although the majority of recurrences are seen within 2 years.

2010 Austrian-Swiss-German Traveling Fellowship Tour Summary

The 2010 Austrian-Swiss-German (ASG) Traveling Fellowship Tour took place between April 5 and May 2, 2010. As is customary, all stops on the tour included visits to the operating rooms and clinics, scientific exchange programs, and time for sightseeing and socializing. The tour began in Munich, Germany, and proceeded to Wurzburg, Germany; Salzburg and Vienna, Austria; Berlin, Cologne, Bonn, Dusseldorf, and Heidelberg, Germany; and Basel, Switzerland. It culminated at the Annual Meeting of the Southern German Orthopaedic Association in Baden-Baden, Germany. Traditionally, there have been two American fellows, one British fellow, and one Canadian fellow. This year, the Canadian Orthopaedic Society chose not to send a fellow. Because of unforeseen circumstances, including the eruption of the Icelandic volcano that interrupted European air traffic for several weeks, one of the American fellows, Scott Steinmann, MD, a shoulder and elbow specialist from the Mayo Clinic in Rochester, Minnesota, was able to participate only in the last week of the tour. So, for the initial three weeks of the trip, there were just two traveling fellows, Raghuram Thonse, MD, a total joint arthroplasty specialist currently practicing in Oxford, England, and the author, Susan Scherl, MD, a pediatric orthopaedist at the University of Nebraska in Omaha (Fig. 1). Our first stop was Munich, Germany, where we were hosted by Dr. R. Gradinger of the Technical University of Munich (TUM) and Dr. A. Imhoff of Ludwig Maximillian University (LMU). Dr. Thonse arrived the evening of April 5, a day before I did, and spent April 6 in the operating room at TUM. On my arrival, I was taken directly to TUM for the first of the tour’s many scientific sessions. I presented “Pediatric Orthopaedic Problems Related to Childhood Obesity,” and Dr. Thonse presented “Antibiotic Cement-Coated Nails in the Treatment of Infected Nonunion.” (We each …

Indications for Antibiotic Cement Nails

This article focuses on the surgical indications and techniques of antibiotic nailing of the femur. Spanning external fixation is an essential component of damage control orthopaedics. Fractures of the femur with significant soft tissue injury also often require prolonged external fixation, which increases the risk of infection. Antibiotic nails can sterilize the medullary canal contaminated by external fixator pins and prophylax against nosocomial infection, while the pin tracts heal to prepare the canal environment for a future staged metal nailing. Antibiotic nails may also be used as a bridge to definitive metallic intramedullary nailing after spanning external fixation in patients with multiple injuries or mangled limbs.