Indications for Antibiotic Cement Nails

Abstract

This article focuses on the surgical indications and techniques of antibiotic nailing of the femur. Spanning external fixation is an essential component of damage control orthopaedics. Fractures of the femur with significant soft tissue injury also often require prolonged external fixation, which increases the risk of infection. Antibiotic nails can sterilize the medullary canal contaminated by external fixator pins and prophylax against nosocomial infection, while the pin tracts heal to prepare the canal environment for a future staged metal nailing. Antibiotic nails may also be used as a bridge to definitive metallic intramedullary nailing after spanning external fixation in patients with multiple injuries or mangled limbs.

Preliminary outcomes of proximal femur megaspacers

“…Local antibiotic therapy with polymethylmethacrylate (PMMA) and antibiotic-coated spacers (commercially available or manufactured ad hoc) is a recognized technique usually used by surgeons for prosthetic hip [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] and femur shaft infections [13] , [14] , [15] , [16] . However, this strategy has some limitations when treating a proximal femur infection and an infected nonunion of diaphyseal fracture ( Table 1 ) ( Fig.…”

“…One of them is the implantation of the antibiotic cement-coated intramedullary nails used for the treatment of osteomyelitis associated with fractures or infected nonunions of long bones [13] , [14] , [17] . This technique allows intramedullary debridement (through reaming, intramedullary irrigation, and debris removal), provides both fracture stability and high local concentration of antibiotics, and restores limb function by maintaining joint mobility and allowing weight-bearing ambulation.…”

Microbiological and pharmacological tests on new antibiotic‐loaded PMMA‐based composites for the treatment of osteomyelitis

“…and requires a multidisciplinary approach: removal of all implanted devices by the surgical debridement of all infected tissue followed by a specific systemic antibiotic therapy for at least 4-6 weeks. [3][4][5][6][7] To reduce the risk of infection, the administration of perioperative systemic antibiotic prophylaxis is also a routine procedure. 2 After systemic administration the degree of penetration of antibiotics into the bone is irregular, thus determining variable concentrations that are not always inhibitory and effective.…”

Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

“…It spreads along the length of the nail and involves the entire length of bone [ 12 ]. Multiple points or also the entire medullary canal is involved in pin tract infections after external fixation [ 13 ]. Reported rates of infectious complications after planned conversion from external fixation to intramedullary nailing for the femoral fractures range from 1.7 to 20% [ 14 – 18 ].…”