Intramedullary nails coated with Antibiotic Loaded Acrylic Cement (ALAC) containing 5% of culture specific antibiotic in therapy for infected long bone fractures and nonunions

Abstract

Introduction. Treatment of fractures or non-union of long bones with infection requires debridement of the medullary cavity, antibiotics in high concentra- tions in the bone and biofilm, elimination of dead space in the place of debridement and mechanical stability at the site of infection. External stabilization is inconvenient for the patient and makes skin plastics difficult. Material and methods. There were 13 patients (6 women and 7 men), aged 18-82 years, treated with debridement and stabilization with intramedullary nail covered with Antibiotic Loaded Acrylic Cement (ALAC). Indications for nail covered with ALAC (ACIIN): infected fractures or infected nonunion of the femur (6), tibia (6) and humerus (1) diaphysis. Follow-up: 1-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. Epidermidis (1), mixed infection: MRSA and Pseudomonas aeruginosa (1). Up to 40 g of ALAC with gentamycin in a dose below 1 g were added: 2 g vancomycin (11), 1 g vancomycin and 1 g meropenem (1 – mixed infection), 1 g vancomycin and 1 g ceftriaxone (1– MSSA) – based on preoperative culture . In the absence of a conclusive antibiogram, vancomycin was a pre-emptive therapy, focused on the most common pathogen. Nail locking applied: static (5), dynamic (2); without locking (6). Results. Healing of the infection was achieved in 11, bone union in 9 of 13 patients. Non-union in 4 cases: large segmental defects of the femoral shaft (2); tibial nonunion (2). Conclusions. ACIIN nails with the addition of 5% targeted antibiotic can be an effective treatment for infected fractures or infected nonunions of the femoral, tibial and humeral diaphysis. They offer comfortable bone stabilization and local treatment of infection.