Antibiotic cement-coated rigid locked nails in infected femoral and tibial nonunion. Reoperation rates of commercial versus custom-made nails

by Selleckchem | Mar 24 2023

Introduction: The objective of this study is to assess bone union, infection control, and reoperation rates in a series of patients with infected femoral or tibial nonunion treated with antibiotic-cement-coated rigid nails and to compare the results obtained with custom-made nails versus commercial nails.

Methods: We retrospectively analyzed a series of consecutive patients with infected nonunion of the femur or the tibia treated with antibiotic-cement-coated rigid nails between January 2010 and 2020. We assessed patients' distinctive characteristics, initial injury, type of nail used (custom-made nail with vancomycin or commercial nail with gentamicin), success rate (bone union + infection control), reoperation rate, and failure rate. Comparative analyses were conducted between reoperated and non-reoperated patients regarding the type of nail used. A multivariate regression analysis was performed to assess the risk variables that impacted reoperation rates.

Results: We included 54 patients with 22 (40.74%) infected femoral nonunions and 32 (59.25%) tibial nonunions, who were treated with 38 (70.37%) custom-made antibiotic-cement coated nails and 16 (29.62%) commercial nails. Bone union and infection control were achieved in 51 (94.44%) cases. The reoperation rate was 40.74% (n = 22), and the failure rate was 5.55% (n = 3). The use of custom-made nails was associated with a higher risk of reoperation (Odds Ratio 4.71; 95% Confidence Interval 1.10 - 20.17; p = 0.036).

Conclusion:

Antibiotic-cement-coated nails reached a 94.44% success rate. Nails manufactured in the OR coated with vancomycin cement were associated with a higher risk of reoperation than commercial nails loaded with gentamicin cement.

Comments：This study retrospectively analyzed a series of consecutive patients with infected nonunion of the femur or tibia treated with antibiotic-cement-coated rigid nails between January 2010 and 2020. The aim was to assess bone union, infection control, and reoperation rates and to compare the results obtained with custom-made nails versus commercial nails.

A total of 54 patients were included in the study, with 22 (40.74%) having infected femoral nonunions and 32 (59.25%) having tibial nonunions. Of these, 38 (70.37%) received custom-made antibiotic-cement coated nails, and 16 (29.62%) received commercial nails. The study found that bone union and infection control were achieved in 51 (94.44%) cases. The reoperation rate was 40.74% (n = 22), and the failure rate was 5.55% (n = 3).

The study also found that the use of custom-made nails was associated with a higher risk of reoperation (Odds Ratio 4.71; 95% Confidence Interval 1.10 - 20.17; p = 0.036) compared to commercial nails loaded with gentamicin cement.

In conclusion, antibiotic-cement-coated nails were successful in achieving bone union and infection control in the majority of cases. However, the use of custom-made nails was associated with a higher risk of reoperation compared to commercial nails.