Safety and complications of antimicrobial coated compared to conventional intramedullary femoral nails in proximal femoral fractures.

Purpose: The aim of this study was to compare one-year mortality and the incidence of complications, particularly fracture-related infections, between patients with proximal femur fractures treated with novel noble metal-coated implants and those treated with uncoated implants, to detect possible effects of the coating on these endpoints.

Methods: Design: Retrospective cohort observational study.

Setting: Level 1 trauma centre. Patient Selection Criteria: All patients ≥ 18 years old with proximal femur fracture, who were treated with an intramedullary femur nail between 01.09.2020 and 01.10.2022 were included. The coated group (COATED) included patients who were treated with a coated implant. The control group (CONTROL) was treated with uncoated implants. Pathological fractures were excluded.

Results: 188 patients who matched the criteria were included (COATED: 93, CONTROL: 95). There was no significant difference in the one-year mortality or complication rate between the two groups. The fracture-related infection rate did not differ (p = 0.31) between both groups. Complications were observed in 59% of all cases and the overall one-year mortality rate was 42%. There was a significant correlation between complication occurrence and hospital stay (p < 0.01).

Conclusion: The coated intramedullary nail was similar to the uncoated nail in terms of perioperative complications and 1-year mortality rate. This suggests that the novel coated implant is safe for common clinical use. Further prospective multicentre studies with larger sample sizes are needed to detect a potential impact of coated implants on the incidence of fracture-related infections.