Publication:

Successful management of infected tibia IL nail by debridement, lavage, and antibiotic impregnated v-nail

Background Tibia is a most common subcutaneous long bone which is highly vulnerable for injury. Infected ILN tibia and non-union of tibia is much common in clinical practice which calls for challenging management protocols to control intramedullary infection. Considerable judgment is required to treat an infection in fracture with implant in situ. Mechanical stability and control of infections are two main factors in management of infected tibia with implant in situ. To remove infected material and bio-film by serial reaming of medullary canal, thorough lavage and local debridement of infected fracture site and sinuses is essential and must before inserting antibiotic impregnated nail. According to pharmacokinetic studies, antibiotic delivery from antibiotic impregnated bone cement is 200 times higher concentration than systemic administration without any systemic side effects. Local high antibiotic concentration not only prevents bacterial growth but also prevents bio-film formation by bacteria. The study was conducted to evaluate the efficacy of antibiotic-impregnated PMMA cemented v-nails in managing infected IL Nailing tibia without any bony defects.

Methods They were 10 males and 02 females, with a mean age of 38.5 years. Mean follow-up was of 24 months (range 15-30 months). Mean duration for union was patients were followed up at 4, 8, 12 weeks and 3, 6, 9 and 12 months interval. Functional results were evaluated with regards to control of infection, bony union, deformity, limb length discrepancy and complications (intra and post-operative).

Results Radiological and functional outcome assessed according to complications treated accordingly.

Conclusions IL nail tibia with infection can be treated effectively if control of infection by debridement and mechanical stability (by v-nail), prevention of bacterial growth by antibiotic impregnated V-nail. Control of infection after debridement is addressed by antibiotic impregnated v-nail is the main crux of treatment. After control of infection cemented V-nail is exchanged with standard IL-nail. Bone grafting is optional, if after exchange nailing there is no sign of union by 8 weeks. Insertion of antibiotic impregnated cemented V-nails combined with adequate debridement; lavage and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.