Commercially available antibiotic-laden PMMA-covered locking nails for the treatment of fracture-related infections - A retrospective case analysis of 10 cases

Alberto Jorge-Mora, Samer Amhaz-Escanlar, Sabela Fernandez-Pose, Adrián García-Iglesias, Fermín Mandia-Mancebo, Eloi Franco-Trepat, María Guillán-Fresco, Jesús Pino-Minguez, Alberto Jorge-Mora, Samer Amhaz-Escanlar, Sabela Fernandez-Pose, Adrián García-Iglesias, Fermín Mandia-Mancebo, Eloi Franco-Trepat, María Guillán-Fresco, Jesús Pino-Minguez

Abstract

Introduction: Fracture-related infections (FRIs) are a devastating complication. FRIs are challenging and should be addressed with a multidisciplinary approach. An FRI should be addressed surgically by non-viable bone debridement, local antibiotic deposition, minimization of dead space and fracture stabilization. Antibiotic-laden PMMA-covered nails are a viable option to face these complications. To demonstrate the safety and utility of commercially available antibiotic-laden PMMA-covered nails, we performed a review of the cases operated in our institution and a cost analysis to compare the cost of a commercial nail to other available alternatives. Material and methods: We designed a retrospective study of consecutive cases to demonstrate the safety and efficacy of antibiotic-laden PMMA-covered commercial nails and designed a cost analysis of commercial coated nails compared to other custom-made alternatives. Results: We treated seven tibias and three femurs. Nine patients fully fit the criteria for FRI. There was one case of reintervention because of persistent drainage. All fractures healed, and in the first year post-intervention, there were no signs or symptoms of infection. There were no complications related to the commercially available nail that was used. There is a small increase in the direct quantifiable cost in commercially available nails, but non-quantifiable cost should be assessed individually. Conclusions: Commercially available antibiotic-laden PMMA-covered nails are a safe and useful treatment option for complicated cases of lower limb long bone reconstruction. The low complication rate and the straightforward technique compensate for the direct cost increase in most situations.

Keywords: Infection; antibiotic-laden PMMA-covered nail; fracture-related infection; long bone.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
A: A lateral X-ray shows a broken piece of PMMA in the diaphysis of a tibia after a reconstructive process, indicated by the arrow. B: Image of a nail without mantle break after removal.
Figure 2
Figure 2
Images that show the reconstructive steps of a tibial non-union. Images A and B: Anteroposterior and lateral X-ray. Image C: Teleradiograph in full-weight. Image D: Intraoperative correction with a distractor and RIA reamer. Images E and F: postoperative anteroposterior and lateral X-ray after non-union treatment.
Figure 3
Figure 3
Image A: Postoperative image of the debridement of a sequestrum. Image B: Acute postoperative fracture after debridement. Images C and D: Anteroposterior and lateral X-ray after fixation.

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