Outcome of treating osteomyelitis and infected non-union of long bones with antibiotic coated bone cement nails

Abstract

Introduction: Nonunion in the presence of infection poses the combined dilemma of infection management and stability. The purpose of this research was to determine the function of antibiotic cement coated nailing in infection management and bony union of infected non-union of long bones. Methodology: This prospective observational study was conducted in the Department of Orthopedics, Janki Medical College, Janakpur, Nepal from August 2016 till August 2021. In this study, we included patients aged 18 years or above, who were treated with antibiotic cement coated nailing for infected nonunion post-operative fractures of tibia or femur. 2 g of vancomycin and 2 g of gentamycin were put into every 40 g of bone cement. Clinical, radiographic, and haematological markers were used to assess infection control and osseous union. Results: In the present study, 50 patients were included, with a mean age of 37.3 ± 6.2 years, and 72% of the patients were males (n=36) and rest being females (28%, n=14). Tibia was involved in 60% of the cases and rest had their femur involved. Wound culture revealed staphylococcus aureus in 60% of the patients and Enterobacter in 20% of the patients. At 6 months, bone union was achieved by 92% of the patients, infection control was achieved in 94% and 90% had no complications. Reinfection was observed in four cases (4%), nail break, nail migration and malunion was observed in one patient each. Conclusions: Based on the results, it appears that antibiotic cement coated nailing in the therapy of infected non-union of long bones is a good method for achieving early infection control.