Use of Custom-Made Antibiotic Coated Intra-Medullary Nail in Treatment of Infected Non-Union of Long Bones

Pruthi, Vineet; Ummat, Ashwani; Singh, Manjeet; Kochhar, Sonia; Pathak, Subodh Kumar; Verma, Vishesh; Sharma, Aman

doi:10.37506/v11/i2/2020/ijphrd/194910

Cited by 4 publications

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“…Pruthi et al. 2020 [ 24 ] Case series 30 patients Intramedullary tibial nails (7–8 mm in diameter), Intramedullary femoral nails (8–9 mm in diameter), or K-nails (in 9 cases) Infected nonunions of long bones with defects size of less than 3 cm (9 femurs, 20 tibias, 1 humerus) Gentamicin-containing bone cement (not further specified) 4 g vancomycin per 40 g cement or 2 g vancomycin and 2.4 g tobramycin per 40 g cement Circumferentially 2 mm in thickness Custom-made molds. Sterile lubricant gel was used on molds before placing the cement.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment with antibiotic-containing cement- or bone graft substitute-coated orthopedic implants was not only performed as the initial revision procedure to aid in eradication of infection with simultaneous limited construct stability later needing further revision surgery for definitive fixation [ 10 – 14 , 21 , 23 , 29 – 38 ] ( n = 17), but also as the main definitive revision procedure with either no further planned procedures [ 8 , 9 , 15 , 17 , 19 , 20 , 22 , 24 – 26 , 28 , 39 – 45 ] ( n = 18) or additional surgery solely to remove the coated implants after completed healing and controlled infection [ 16 , 46 , 47 ] ( n = 3). Some studies ( n = 2) also implemented antibiotic-containing cement-coated implants as part of a three-stage revision procedure protocol [ 18 , 48 ].…”

Section: Methodsmentioning

confidence: 99%

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Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

et al. 2021

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Background Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use. Methods A systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible. Results A total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant. Conclusion Adequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted. Level of evidence III.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

et al. 2021

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“…Despite clinical symptoms of illness, eight people had negative cultures. Staph aureus was isolated from 17 people, 10 of whom had MRSA, according to Pruthi et al [5] Five patients were infected with Klebsiella, three with pseudomonas aeruginosa, and four with symptoms but no organism was collected. Numerous microbes were found in the remaining patients.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with history of allergy to vancomycin, had chronic osteomyelitis, a pathological or tumor-related fracture, polytrauma, an additional fracture that might impair functional outcome, presented with distal neurovascular deficit, and were lost to follow-up were excluded from the research. Pruthi et al reported infection control in 90% of the patients using antibiotic coated intramedullary nail in treatment of infected non-union of long bones [5] . The sample size was calculated using following formula N = (Z α/2 ) 2 * (PQ) / E 2 , where N = Sample size, Z α/2 = Z value at 5% error (1.96), P = taken as 90%, Q = 1-P and E = allowable error (taken as 10% of P) N = [(1.96) 2 * (0.9*0.1)] / (0.09) 2 = 42.68.…”

Section: Methodology Study Design and Samplingmentioning

confidence: 99%

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

Gupta¹,

Chaurasia²,

Goit³

2022

Int. J. Orthop. Sci.

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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.

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“…First described in 2007, ACCINs offer the advantages of providing both antibiotic delivery and bone stability [ 1 ]. The literature shows multiple studies involving ACCINs that have demonstrated their successful implementation to treat infected nonunions and arthrodeses [ 2 , 3 , 4 , 5 , 6 ]. The 2018 International Consensus Meeting on Musculoskeletal Infection agreed that antibiotic-coated intramedullary nails were an effective treatment for these difficult cases [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Infection Eradication in Antibiotic Cement-Coated Intramedullary Nails for Fracture-Related Infections, Nonunions, and Fusions

et al. 2022

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Antibiotic cement-coated intramedullary nails (ACCINs) are increasing in popularity as a viable solution for the treatment of fracture-related infections (FRIs), infected long bone nonunions, and arthrodeses without an external fixator. ACCINs effectively manage to fulfill three of the basic principles for eradicating osteomyelitis: dead space management, antibiotic delivery, and bone stability. We performed a retrospective review of 111 patients who were treated with ACCINs between January 2014 and December 2020. In our series, 87.4% (n = 97) of patients achieved healed and uninfected bone or stable arthrodesis at a mean follow-up of 29.2 months (range, 6–93 months). Additionally, 69.1% (n = 67) of healed patients were resolved after only one procedure, and the remainder (30.9%, n = 30) healed after one or more additional procedures. The mean number of additional procedures was 2.1 (range, 1–6 additional procedures). The overall limb salvage rate was 93.7% (n = 104). The majority of the total cohort were successfully treated in only one surgery. This study suggests that ACCINs are effective in the treatment of FRIs, infected long bone nonunions, and infected ankle and knee arthrodeses.

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Use of Custom-Made Antibiotic Coated Intra-Medullary Nail in Treatment of Infected Non-Union of Long Bones

Cited by 4 publications

References 0 publications

Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

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

Efficacy of Infection Eradication in Antibiotic Cement-Coated Intramedullary Nails for Fracture-Related Infections, Nonunions, and Fusions

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