Abstract
Problems of infected non-unions include not only infection and impossibility of weight-bearing, but also restricted ROM and compromised soft-tissues as result of trauma and previous surgeries. In such cases, treatment is long and difficult both for patient and treating surgeon. This study was performed to evaluate the efficacy of using antibiotic-impregnated cement locked nails for management of this condition.
The study included 28 patients with infected non-unions of femur (18) and tibia (10) treated from 01.2009 to 11.2013. Mean time from the injury to AB-cement nailing was 16.5(9–27) months. 4/18 femoral and 5/10 tibial fractures were open. Other fractures were closed and infected non-union developed as complication of previous surgeries: IM-nailing, ORIF or Ilizarov external fixation. Fistulas were revealed in all patients, but have closed by the time of AB-cement nailing in 18 cases. Pre- and intraoperative cultures revealed S.aureus in 18, S.epidermidis in 5, no grows in 5 cases. Solid stainless-steel locked nails (SIGN) were coated with AB-cement intraoperatively. Full weight-bearing was allowed 3 months after surgery. Follow-upwas performed in 6, 12, 24 and 52 weeks.
One year after surgery, X-ray revealed bone union in 25 (89.3%) patients and all 28 (100%) patients were full weight-bearing. In 3 (10.7%) cases, X-ray has revealed evident fracture line. Open fistulas were found in 4(14.3%) patients and required hardware removal and debridment.
AB-cement locked nailing achieved elimination of infection and fracture healing in the majority of patients. This method can be considered as effective and requires further studies.
