Antibiotic Impregnated Cement coated Nailing in Management of Infected Non-union of long bone diaphyseal fractures
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 1, Pages 3087-3094
AbstractInfected nonunion of long bones is a chronic and debilitating disorder. The problems in treating them are infection, instability, and deformity. Traditionally, it is managed by two- stage procedure for controlling the infection first and then treating the nonunion. Effectiveness of antibiotic impregnated cement coated intramedullary nail as a single stage treatment modality for treating infection and achieving stability at the same time has been described in the literature currently..
Materials and Methods: Fifteen patients (above 18 years of age) with infected non-union of femur and tibia were selected and surgically treated with antibiotic cement coated iln. Antibiotic cement nail was prepared using endotracheal tube method. Antibiotics used are vancomycin 4 mg . Functional results were evaluated with regard to control of infection, bony union, and complications.
Results: Infection was controlled in 85% of the patients. With Average period of follow-up of 12 months bony union was achieved in 10 of 15 (66%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Remaining 5 patients required additional procedures like bone grafting or exchange nailing and these were done in two patients, with union of fracture. Recurrence of infection occurred in two cases. Complications encountered were difficult nail removal in two cases, broken nail in one case, and bent nail in one case.
Conclusion: Antibiotic cement impregnated nailing is a simple, economical and effective single stage procedure with better patient compliance for the management of infected nonunion of long bones. Instruments are easily available and performed at any orthopaedic center.
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