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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 41 - 41
1 Dec 2016
Bondarev O Volotovski P
Full Access

Aim

We performed this Institutional Review Board-approved study to evaluate the efficacy of antibiotic-impregnated cement nailing for management of this condition.

Method

The study included 41 patients with infected non-unions of femur (23) and tibia (18) treated from 01.2009 to 09.2014. 32 (78%) patients were male and 9 (22%) patients were female. Mean age was 41.8 (range 20–78) years old. Mean time from the injury to AB-cement nailing was 21.2 (range 6–91) months. Mean follow-up duration was 18 (8–36) month. 6/23 femoral and 9/18 tibial fractures were initially open. Other fractures were closed and infected non-union developed as complication of previous surgeries: IM-nailing, ORIF or Ilizarov external fixation. Sinuses were revealed in all patients, but have closed by the time of AB-cement nailing in 30 cases. Pre- and intraoperative cultures revealed S.aureus in 20, S.epidermidis in 8, Klebsiella Pneumoniae in 3, Enterobacter cloacae in 2, Acinetobacter baumannii in 1 and no grows in 7 cases. We used 9–12 mm nails* for femur and 8–10 mm for tibia with 2 mm cement thickness. Gentamicin-impregnated cement was mixed with thermostable antibiotic according to the predetermined sensitivity (vancomycin or daptomycin). Nails were coated using silicone tube with equal diameter for the entire length. After debridement and preparation of intramedullary cavity with reamers the locked IM-osteosynthesis was performed. In all cases nails were locked proximally and distally to improve bone stability. Patients additionally received intravenous antibiotics according to the sensitivity for two weeks. Full weight-bearing was allowed 3 months after surgery. Follow-up was performed in 6, 12, 24 and 52 weeks.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 66 - 66
1 Dec 2015
Bondarev O Sitnik A Volotovski P
Full Access

Problems of infected non-unions include not only infection and impossibility of weight-bearing, but also restricted ROM and compromised soft-tissues as result of trauma and previous surgeries. In such cases, treatment is long and difficult both for patient and treating surgeon. This study was performed to evaluate the efficacy of using antibiotic-impregnated cement locked nails for management of this condition.

The study included 28 patients with infected non-unions of femur (18) and tibia (10) treated from 01.2009 to 11.2013. Mean time from the injury to AB-cement nailing was 16.5(9–27) months. 4/18 femoral and 5/10 tibial fractures were open. Other fractures were closed and infected non-union developed as complication of previous surgeries: IM-nailing, ORIF or Ilizarov external fixation. Fistulas were revealed in all patients, but have closed by the time of AB-cement nailing in 18 cases. Pre- and intraoperative cultures revealed S.aureus in 18, S.epidermidis in 5, no grows in 5 cases. Solid stainless-steel locked nails (SIGN) were coated with AB-cement intraoperatively. Full weight-bearing was allowed 3 months after surgery. Follow-upwas performed in 6, 12, 24 and 52 weeks.

One year after surgery, X-ray revealed bone union in 25 (89.3%) patients and all 28 (100%) patients were full weight-bearing. In 3 (10.7%) cases, X-ray has revealed evident fracture line. Open fistulas were found in 4(14.3%) patients and required hardware removal and debridment.

AB-cement locked nailing achieved elimination of infection and fracture healing in the majority of patients. This method can be considered as effective and requires further studies.