Fracture-related infection is a serious complication in orthopedic surgery with severe consequences for the patient. We evaluated whether a novel noble metal nail-coating technology can prevent bacterial adhesion and biofilm formation without interfering with bony union. In this retrospective, single-center case series, we described the incidence of fracture-related infections and bony union achievement in patients who had Gustilo type IIIa or IIIb femoral or tibial fractures treated with noble metal alloy-coated titanium nails. Patients were treated between January 2017 and January 2019 at the Sultanah Aminah Hospital, Johor Bahru, Malaysia. Information on fracture-related infections and bone healing assessments was collected from patient records. Additionally, three independent experts retrospectively reviewed patient X-ray images from follow-up visits to further evaluate bony union achievement. Thirty-five patients were included. Infection developed in 3/35 (8.6%) patients; all cases were resolved by antibiotic therapy. Radiographs were available for 32 patients; these confirmed the presence of bone healing in 30/32 (93.8%) patients. However, according to patient records, bony union was achieved in all patients. No safety issues were recorded. This case series suggests that a noble metal alloy-coated titanium nail can prevent infection and facilitate bony union achievement in patients undergoing surgery for severe open fractures.

Periprosthetic fracture of the femur is an uncommon complication after total hip arthroplasty (THA), but it appears to be increasing in incidence as a result of the aging population demographics and the increased number of THAs that are being performed. Much interest has been generated regarding low energy fractures in the elderly, but repeated periprosthetic fractures in the same femur are uncommon. The authors present here the case of a 71 year old patient who sustained repeated low energy ipsilateral periprosthetic femur fractures. The initial injury was caused by a road traffic accident, but the subsequent fractures were all caused by low energy falls. The patient sustained proximal and distal femur fractures with implants in situ. The probable causes of such fractures was a combination of systemic and local host factors, such as osteoporosis, cortical stress risers, local osteopenia secondary to bed rest, quiescent infection and altered fracture site vascularity due to the internal fixation devices and multiple re-operations.