Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Hong-An Zhang, Chun-Hao Zhou, Xiang-Qing Meng, Jia Fang & Cheng-He Qin. BMC Musculoskeletal Disorders volume 21, Article number: 710 (2020).
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Infection after intramedullary nailing has a reported infection rate in the literature of between 0.9% and 3.8%. Although the infection rate is not high, the management of this type of infection remains controversial. In this study the records of patients diagnosed with an infection after intramedullary nail fixation from 2014 to 2017 were retrospectively analysed. The management of these patients included intramedullary nail removal, local debridement, medullary canal reaming, irrigation and antibiotic loaded STIMULAN (500mg Vancomycin/80mg Gentamicin per 5cc) implantation with or without secondary osteotomy and distraction osteogenesis. Infection remission, bone union and drainage rates were all evaluated. A total of 19 patients who met the inclusion criteria were included in the analysis. Results showed 18/19 (94.7%) achieved infection remission; 1 patient developed a reinfection which resolved after repeat debridement. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. This study describes an effective method to eliminate infection after intramedullary nailing. All patients received the same surgical management as detailed previously and overall, the outcomes were good. Further prospective studies with larger case numbers are necessary to confirm these findings. The abstract can be read, and the full paper can be obtained here

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