Cement-coated Nail Research Articles

Antibiotic-impregnated cement-coated intramedullary nail in primary fixation of compound fractures of tibial shaft – A comparative study with external fixator in terms of infection control

Introduction: Compound tibial shaft fractures are conventionally managed by debridement and primary stabilization by external fixators, followed by definitive fixation after the wound healing; however, many problems such as infection, difficult soft tissue reconstruction, and psychosocial effects encountered. Hence, a technique of antibiotic-impregnated cement-coated intramedullary nailing has been advocated. Aims: The aim of the study is to compare functional and biological outcomes of antibiotic-impregnated cement-coated nail with external fixators. Settings and Design: This was a prospective interventional study. Subjects and Methods: A total of 20 patients with Compound Grade 3A and 3B (Gustilo and Anderson) tibial shaft fractures who met the inclusion and exclusion criteria from January 2020 to June 2021 were selected. Group 1 was operated with antibiotic-impregnated cement-coated nails. Group 2 was operated with external fixators. Clinical and laboratory parameters were used to evaluate infection control. Final follow-up was taken at 6 weeks. Results: The infection rate after nailing was 10% in Group 1 (1/10) and 50% in Group 2 (5/10). Intraoperative time taken for soft tissue reconstruction procedures after primary fixation such as flap cover and skin grafting was comparatively less in Group 1 (mean time – 32 min ± 6.23) compared to Group 2 (51 min ± 5.83). Duration between primary and definite fixation was comparably less in Group 1 (mean duration 5.7 weeks ± 0.45) compared to Group 2 (6.3 weeks ± 1.004). Conclusions: Primary antibiotic-impregnated cement-coated nail is better than external fixator in terms of infection control and providing stability in compound fractures of shaft of tibia.

Outcome of intramedullary nail coated with antibiotic-impregnated cement in chronic osteomyelitis.

Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants. Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases. Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters. Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.

The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis - comparative analysis of custom-made versus commercially available nails.

Background: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement–nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results: Thirty patients were included. The affected bones were the femur () and the tibia (). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement–bone debonding. Commercial nails were associated with shorter operating times (). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement–bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.

An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

Tibiotalocalcaneal Fusion With Antibiotic Cement-Coated Nails for Refractory Deep Infection After Ankle ORIF.

Deep infection after open reduction internal fixation (ORIF) of ankle fractures represents a challenge to the orthopaedic surgeon, particularly in patients in whom conventional surgical treatments have failed. The aim of this study was to assess the results of a modified technique of tibiotalocalcaneal fusion using a retrograde locked intramedullary nail covered in cement with antibiotics. Six patients treated using the authors' technique were analyzed retrospectively. All patients had deep infection after ankle osteosynthesis and several surgical procedures (debridement, external fixation, etc) had failed. Radiographs were analyzed to confirm the healing of the bone. Outcome was measured by maintained construct stability and eradication of infection (no clinical signs of infection and normal values of laboratory markers). The average age of the series was 64.2 (range, 50-75) years, and the average follow-up period was 19.5 (range, 8-41) months. Tibiotalocalcaneal stability and eradication of the infection were achieved in all patients, along with the normalization of clinical and radiologic parameters. In the patient who underwent a talectomy, one of the calcaneal locking screws broke, with no clinical repercussions. Tibiotalocalcaneal fusion with antibiotic cement-coated retrograde nails was useful in providing clinically acceptable results in the control of chronic infection in complex patients after the failure of previous surgeries. Level IV, therapeutic study.

抗生剤含有セメントネイル, Masquelet法, Ilizarov法で治療した脛骨骨幹部開放骨折に対する髄内釘後の化膿性骨髄炎

抗生剤含有セメントネイル, Masquelet法, Ilizarov法で治療した脛骨骨幹部開放骨折に対する髄内釘後の化膿性骨髄炎

Advanced concepts in knee arthrodesis.

The aim is to describe advanced strategies that can be used to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.

Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia: Midterm results in 10 cases

IntroductionThis is a single, level 1 trauma centre, prospective consecutive patient series with intramedullary infection in the presence of unstable tibial fracture treated using the Kirschner wire-reinforced, antibiotic cement nail. Patients and methodsA total of 10 consecutive patients (eight males and two females) with a mean age of 42 years (range, 20–59) suffering from infection after intramedullary nailing for tibial fracture, admitted during a period of 4 years, were included. An antibiotic cement-coated nail, handmade at the time of surgery, was implanted in all patients. This was followed by a standardised 6-week treatment protocol, extraction of the nail and definitive fixation. ResultsAt 6 years of follow-up, infection eradication and bony union were possible in all of the patients. No further infection treatment was necessary; however, all of our patients underwent additional procedures (mean: four additional procedures per patient) for cosmetic or other non-infectious reasons (bone grafting, muscle flaps, etc.). ConclusionsThe antibiotic cement-coated nail seems to be an effective treatment for intramedullary infections of the fractured tibia.

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 …

Antibiotic Cement-Coated Nails for the Treatment of Infected Nonunions and Segmental Bone Defects

Thonse, Raghuram MS(Orth), DNB(Orth), FRCS(Glasg), FRCS(Ed)1; Conway, Janet D. MD2 Author Information

Antibiotic Cement-Coated Interlocking Nail for the Treatment of Infected Nonunions and Segmental Bone Defects

Chronic infection of bone with nonunion and/or bone defects is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which antibiotic cement-coated interlocking intramedullary nails are prepared in the operating room with the use of nails and materials that generally are available is herein described. Although useful for all infected nonunions and/or segmental bone defects, this technique is particularly useful for patients who are not ideal candidates for external fixation and for those who do not want to have an external fixator applied. This technique was used in a series of 20 patients. In 17 patients, the goal of bony union was achieved (85%). In the remaining 3 patients (15%), the goal of control of infection was achieved with stable nonunion (1 patient) and stable nonunion with cement spacer (2 patients). In 95% of the patients (19 of 20 patients) control of infection was achieved except for in 1 patient, who had a bony union with intermittent wound discharge and subsequently underwent an above-the-knee amputation. Three patients (15%) needed exchange nailing to another antibiotic cement-coated nail (for continued infection) before complete control of infection could be achieved. Four patients (20%) experienced cement-nail debonding during removal of the antibiotic cement-coated nail (3 during exchange to an uncoated intramedullary nail, 1 during removal at the request of patient). One patient experienced partial debonding at insertion, coinciding with the site of segmental defect, which was treated with an antibiotic cement spacer. In summary, control of infection and stability to promote union has traditionally been provided by 2 separate procedures, which have proved to be efficacious in the past. However, both these goals can be achieved in half the patients with 1 surgical procedure in a variety of scenarios using the technique of an antibiotic cement-coated intramedullary nail.

The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours.

We have studied 35 patients with infected reconstructions after segmental resection for bone tumours. Two different regimes of treatment were employed both of which entailed debridement and the use of cement impregnated with antibiotic. In 25 patients gentamicin-PMMA beads were used and in ten an antibiotic-impregnated cement spacer. Better results were achieved with the second procedure in terms of cases healed, the number of operations, time of healing, time of recovery and the functional score. The use of vancomycin in the cement spacer gave better local control.