Publication:

Role of antibiotic-coated intramedullary nails and antibiotic beads in the management of infected nonunion of long bones

Background Infected non-union of long bones remains a challenging condition in orthopaedic practice because of the coexistence of infection, bone instability and impaired fracture healing. Antibiotic-coated intramedullary nails and antibiotic beads provide simultaneous local antibiotic delivery and mechanical stabilization, thereby improving infection control and fracture union. To evaluate the clinical and functional outcomes of antibiotic-coated intramedullary nails and antibiotic beads in the management of infected non-union of long bones.

Methods This prospective study included 20 patients with infected non-union of long bones treated with antibiotic-coated intramedullary nails and antibiotic beads between January 2024 and January 2026. Clinical, microbiological, radiological and functional outcomes were assessed. Infection control, fracture union, time to union, complications and functional outcomes according to the Paley scoring system were evaluated during follow-up.

Results The majority of patients belonged to the 21–30 years age group (35%). The tibia was the most commonly affected bone (60%), followed by the femur (40%). Staphylococcus aureus was the most common organism isolated (50%). Infection control was achieved in 70% of patients, while radiological union was observed in 80% of cases. The mean time to union was 26.25±5.57 weeks. According to the Paley functional scoring system, excellent and good outcomes were achieved in 45% and 25% of patients respectively. Postoperative complications were absent in 70% of patients, while reinfection occurred in 20%, implant failure in 5% and persistent sinus in 5% of cases.

Conclusions Antibiotic-coated intramedullary nails and antibiotic beads are effective treatment modalities for infected non-union of long bones, providing satisfactory infection control, fracture union and functional outcomes. The combined advantages of local antibiotic delivery and mechanical stabilization make this technique a reliable option in the management of infected non-union.