The treatment of infected nonunions is difficult. Antibiotic cement-coated (ACC) rods provide stability as well as delivering antibiotics. We conducted a review of 110 infected nonunions treated with ACC rods. Patients were divided into two groups: group A (67 patients) with an infected arthrodesis, and group B (43 patients) with an infected nonunion in a long bone. In group A, infected arthrodesis, the success rate after the first procedure was 38/67 (57%), 29/67 (43%) required further surgery for either control of infection or non-union. At last follow-up, five patients required amputation, representing a limb salvage rate of 62/67 (93%) overall. In all, 29/67 (43%) presented with a bone defect with a mean size of 6.78 cm (2 to 25). Of those with a bone defect, 13/29 (45%) required further surgery and had a mean size of defect of 7.2 cm (3.5 to 25). The cultures were negative in 17/67 (26%) and the most common organism cultured was methicillin-resistant staphylococcus aureus (MRSA) (23/67, (35%)). In group B, long bones nonunion, the success rate after the first procedure was 26/43 (60%), 17/43 (40%) required further surgery for either control of infection or nonunion. The limb salvage rate at last follow-up was 43/43 (100%). A total of 22/43 (51%) had bone defect with a mean size of 4.7 cm (1.5 to 11.5). Of those patients with a bone defect, 93% required further surgery with a mean size of defect of 5.4 cm (3 to 8.5). The cultures were negative in 10/43 (24%) and the most common organism cultured was MRSA, 15/43 (35%). ACC rods are an effective form of treatment for an infected nonunion, with an acceptable rate of complications.

Cite this article: Bone Joint J 2014; 96-B:1349–54

Nonunions and segmental bone defects associated with infection are challenging problems faced by the orthopaedic surgeon. Antibiotic cement-coated (ACC) interlocking nails, prepared in the operating theatre using nails and materials generally available, can be used to treat these conditions. Two different types of moulds can be used (reusable or disposable).

Materials and Methods: The infected nonunion/segmental bone defect was treated by débridement followed by ACC nailing in 52 patients (12 female, 40 male, age range 16–86 years). Other procedures for deformity correction, bone defect etc were carried out simultaneously as indicated. Infected nonunion was seen in 34 patients, 1 was an acute fracture after external fixator. Segmental defect in the bone of 1 to 30 cm was seen in 17 patients. Anatomical sites included Femur (13), Tibia (11), Knee (12) and ankle (16).

Results: Limb salvage was achieved in 96% and amputation in 2 patients. Bony union was achieved in 41 of 49 patients (84%). In 3 patients (15%), control of infection was achieved with stable nonunion (1 patient) and stable nonunion with cement spacer (2 patients). Control of infection was achieved in 85%. Single procedure achieved this goal in 73%. Cement nail de-bonding occurred during removal in 9 patients and during insertion in 1 patient. The average follow-up was 16 months (1 to 60 m).

Conclusion: Dual goals of control of infection as well as stability to promote union can be achieved using this technique. Although useful for all infected nonunions, this technique is particularly useful for patients who are not ideal candidates for external fixators or those who do not want an external fixator.