Septic complications of long bone fracture are still a significant clinical problem. Although inflammatory process after intramedullary nailing is a rare complication, its treatment is complex. The aim of this study is to analyze the effectiveness of the treatment of septic complications of the long bone union with use of Reamer–Irrigator–Aspirator (RIA) technique and intramedullary antibiotic-coated PMMA nailing. An analysis of the effectiveness of treatment of 49 patients with septic non-union of long bones (12 femur, 37 tibia), in which the RIA method was applied with antibiotic cement impregnated intramedullary nailing. Treatment consisted of reaming of long bone canal using the RIA technique and the intramedullary cement coated nail with the targeted antibiotic. Treatment required second stage with nail exchange and PMMA removal after 6 weeks to prevent the resitant strains selection. In a group of patients treated with use of above-mentioned method the remission of inflammatory process was achieved in all cases. 32 (67%) patients developed bone union, 24 patients with tibial and 8 patients with femoral septic bone union disorders. The average duration of bone union obtainment with intramedullary nailing was 37 weeks. The most common inconveniences that occurred during treatment was prolonged wound discharge and pain.
Inflammatory complications of fractures in our material involved extensive injuries, usually high-energetic. Stabilization with intramedullary locked nail coated with antibiotic cement after debridement with RIA method is a convincing treatment. An essential element of biological bone union is to provide a good cover of the bone tissue with a soft tissue envelope and sequestrectomy. The success of the treatment of infected pseudoarthrosis may be obtained under condition of: radical removal of inflammation tissue, convincing biomechanical dynamized stabilization and antibiotic therapy.
