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Antibiotic-coated nails effective for treating infected tibia fractures
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SAN FRANCISCO — Trauma surgeons report that it is safe and effective to use Ender's or Rush nails coated in the operating room with antibiotics mixed into cement to treat infected tibial fractures.
"Antibiotic nails deliver high concentrations of antibiotics locally and provide soft tissue stability and enhance patient mobility," said Madhusudhan R. Yakkanti, MD, in a presentation here at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.
German traumatologists developed the concept of using antibiotic-coated nails in the early 1990s to treat osteomyelitis, he noted.
Yakkanti and colleagues studied the treatment, which was used in 21 patients treated at their Level 1 trauma center between April 2002 and November 2004. Most patients had methicillin-resistant Staphylococcus aureus (MRSA) infections. However, investigators selected an antibiotic appropriate to use for fighting the infecting organism based on cultures of each individual case.
They typically added about 4 g of Vancomycin for every two bags of cement used, according to Yakkanti.
"All MRSA patients received 6 weeks of intravenous (IV) antibiotics," he said, noting that all patients were treated with IV antibiotics for at least 48 hours, regardless of the infecting organism.
Nearly equal numbers of fractures in the series were open and closed, with the most common type of open fracture being Gustilo Grade 3A, Yakkanti said.
Patients were treated with the antibiotic-coated nails for an average of 16 weeks. At 34 months mean follow-up, all patients' infections were eradicated.
There were three cement fractures among the complications, which mostly occurred early in the investigators' learning curves at the tip of the nail, Yakkanti reported.
For more information:
- Yakkanti MR, Malkani AL, Roberts CS, et al. Treatment of infected tibia fractures with an antibiotic nail. Paper #501. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.