Aim

The treatment of fracture-related infections (FRI) focuses on obtaining fracture healing and eradicating infection to prevent osteomyelitis. Treatment guidelines include removal, exchange, or retention of the implants used according to the stability of the fracture and the time from the infection. Infection of a fracture in the process of healing with a stable fixation may be treated with implant retention, debridement, and antibiotics. Nonetheless, the retention of an intramedullary nail is a potential risk factor for failure, and it is recommended to exchange or remove the nail. This surgical approach implies additional life-threatening risks in elderly fragile hip fracture patients.

Our study aimed to analyze the results of implant retention for the treatment of infected nails in elderly hip fracture patients.

Introduction and Objectives: The disadvantages attributed to unreamed intramedullary nails in fractures of the femoral diaphysis include delayed fracture consolidation and fatigue of the material. The aim of our study is to describe the low incidence of these complications.

Materials and Methods: We present a series of 25 patients treated by means of 26 unreamed femoral nails (Synthes) and static locking in all cases and follow up until the time of bone healing (6 months). Mean age of the patients was 43 years (range 18–86 years). The most common cause of injury was automobile accident. All treated fractures were located in the diaphysis (32-A in 9 cases, 32-B in 15 cases, and 32-C in 2 cases) and were closed fractures, except in 4 cases (2 Gustillo type II and 2 of type IIIa). In only 6 patients was the femoral fracture the sole lesion. In the rest of the patients, it was accompanied by other skeletal (multiple fractures) or visceral (polytraumatic) lesions.

Results: We were able to achieve fracture consolidation within a period ranging from 2 to 6 months (mean 4.2 months). We did not experience any problems with material fatigue in any of the cases. In one case it was necessary to remove the static lock to allow for bone healing due to diastasis of the fracture site.

Discussion and Conclusions: Unreamed intramedullary nails allow for consolidation of fractures of the femoral diaphysis in a period of time of about 4 months, which we consider to be accurate. Furthermore, the absence of reaming is associated with a less severe local reaction, which we consider to be preferable.