Antibiotic artificial bone implantation and external fixation for the treatment of infection after intramedullary nail fixation: a retrospective study of 33 cases

Abstract

Objective To explore the clinical effect of antibiotic artificial bone implantation and external fixation in the treatment of infection after intramedullary nail fixation. Methods We retrospectively reviewed the clinical data of patients with infection after intramedullary nail fixation treated from March 2010 to August 2020. There were 27 males and 6 female, aged from 12 to 67 years (average 42.27 years), 18 cases on the left side and 15 cases on the right side. Among them, 20 cases were open fractures with initial injury and 13 cases were closed fractures. All patients were treated with intramedullary nail removal, local debridement, antibiotic artificial bone implantation and external fixation. Because of bone defects, 19 patients underwent secondary autologous cancellous bone grafting after infection control. Postoperative wound healing, related inflammatory indicators, fixation time, and bone healing time were recorded and followed up. Results The 33 patients were followed up with period of 10 ~ 98 months (average 62.7 months). One patients failed to control the infection effectively after treatment, so received antibiotics artificial bone implantation again. Two patients also received antibiotic artificial bone implants again due to the recurrence of the infection. After treatment, infection was controlled and the fracture healed well. One patient received vacuum sealing drainage (VSD) due to persistent postoperative exudation, and five patients were also cured successfully after continuous dressing. Two patients had sinus tract after surgery, and the wound was cured by continuous dressing change. Nineteen patients received autogenous iliac bone grafts for healing due to bone defects ranging from 3 to 6.5 cm (average 4.15 cm) after infection control. The external fixation time of 33 patients ranged from 4 to 16 months (average 7.79 months), the bone healing time ranged from 4 to 13 months (average 6.67 months), and the related inflammatory indexes returned to normal within 2–8 weeks (average 4.48 weeks). Conclusion Antibiotic artificial bone implantation and external fixation is an effective method for the treatment of infection after intramedullary nail fixation.

Antibiotic artificial bone implantation for the treatment of infection after internal fixation of tibial plateau fractures

“…If the fracture is still in the process of healing, internal fixation is effective after thorough debridement and antibiotic therapy is effective, which can still be selected to control the infection until the fracture healing under circumstance of retaining internal fixation. However, it is necessary to pay close attention to the patient's condition during this process [ 12 ]. Once the infection is not controlled effectively or even shows signs of recurrence, it is necessary to remove the internal fixation immediately and take appropriate measures to control the infection.…”

“…All inflammatory tissues including dead bones, scars and pus were removed completely. In this process, the standard we following was to remove the infected bone until healthy bone tissue reached spotting bleeding, which was called the “chili sign” [ 12 ]. If the patient had intra-articular infections before surgery, thorough debridement should be performed in the articular cavity first, and closed irrigation or vacuum sealing drainage was used to control the infection.…”

“…External fixation was applied timely according to the stability of the fracture end. Drainage tube was placed and wound was sutured [ 12 ].…”

Graphene Oxide-Silver-Coated Sulfonated Polyetheretherketone (Ag/GO-SPEEK): A Broad-Spectrum Antibacterial Artificial Bone Implants

“…7,8 Currently, infection stands out as one of the most critical complications in artificial bone implantation surgeries, leading to persistent wound nonhealing, implant loosening, and even severe complications such as systemic infection shock. 9 This issue is particularly pronounced due to the diverse and antibiotic-resistant nature of the bacteria-causing infections, contributing to a continuous increase in postoperative infection rates. Consequently, research on artificial bone materials involves endowing SPEEK with broad-spectrum antibacterial capabilities.…”