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

• Published in: Injury 2023-11, Vol.54 Suppl 6, p.110650-110650, Article 110650
• Main Authors: Garabano, Germán, Pereira, Sebastian, Alamino, Leonel Perez, Munera, Mateo Alzate, Ernst, Glenda, Bidolegui, Fernando, Pesciallo, Cesar Angel
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents; Bone Cements; Bone Nails; Femur; Fracture Fixation, Intramedullary - methods; Gentamicins; Humans; Nails; Reoperation; Retrospective Studies; Tibia - surgery; Tibial Fractures - complications; Tibial Fractures - surgery; Treatment Outcome; Vancomycin
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.02.033

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. 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. 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). 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. III comparative, observational, non-randomized.