Introduction

Locking nail have considerably improved the treatment of long weight bearing bones. However, distal locking needs experience and may expose to radiations. Many methods have been proposed to facilitate distal locking and improve safety. Recently, an external distal targeting device adapted to the ancillary of the Long Gamma Nail has been proposed. We report our experience with this device through a comparative series of distal lockings. Aim of this work was to assess feasibility and advantages brought about with this targeting device when considering time or dose of irradiation.

Purpose: Treatment of infection in patients with an unstable bone is based on removal of implants, bone resection, reconstruction, and external fixation. We report a retrospective series of 11 patients who developed post-traumatic osteitis of the tibia on an unstable bone who were treated by removal of all implants, cleaning, antibiotics, and internal fixation using a centromedullary locked nail.

Material and methods: The series included seven men and four women, mean age 32.4 years (16–56). Initially, there were two closed fractures and nine open fractures (Gustilo II: 4, IIIA: 1; IIIB: 4) treated by external fixation in six cases, centromedullary locked nailing in four and plate fixation in one. Bacteriology results were available for all deep surgical samples. The initial implants were removed in all cases, followed by debridement sparing soft tissue, and reaming of the bone. Adapted antibiotics were prolonged for three months. Refixation using a centromedullary locked nail was performed at the first revision time in two cases and later after cleaning in nine (mean delay 28 days, range 2–53 days). Two cases required a flap for cover.

Results: There were two failures: one due to recurrent infection with a different germ, the other due to necrosis of a latissimus dorsi flap followed by amputation. There were nine successes with bone healing in all cases (first intention in eight and after complementary bone graft in one) and no recurrent infection at the current mean follow-up of 2.6 years.

Discussion: These eleven cases have a common feature of no extensive bone necrosis or major bone defect. Bone resection was basically related to reaming with a minimalistic approach for soft tissue debridement. Reliable bacteriological examinations, effective antibiotic therapy, and prolonged and rapid skin cover are essential elements for success.

Conclusion: This experience is limited but does demonstrate that locked centromedullary nailing can be successful for the treatment of long bone infections on unstable bones, considering that this could be the ideal fixation method.