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6 - Efficacy of fixation technique using antibiotic cement-coated intramedullary nail in infected pseudarthrosis
Ferdi Dırvar, Sami Sökücü, Bilal Demir, Umut Yavuz, Yavuz Selim Kabukçuoğlu
Objective: Non-union accompanied by infection requires both the treatment of infection and stabilization of the fracture. This study examined the efficacy of a fixation technique using antibiotic impregnated polymethylmethacrylate (PMMA) cement-coated intramedullary nail in patients with infected pseudarthrosis of the femur or tibia.
Material and Methods: Fourteen patients with Cierny-Mader stage 4 infected non-union of the femur or tibia were included. Patients were treated with local debridement, antibiotic containing PMMA cement-coated intramedullary nail application and systemic antibiotics. They were followed-up for union and recovery of infection.
Results: Femoral and tibial pseudarthrosis were present in 3 and 11 patients, respectively. Eleven patients had hypertrophic and three patients had atrophic infected non-union. The mean duration of follow-up was 24.7 months (range: 8-37 months). During follow-up, infection improved in 85.7% of the cases (12 patients). Union was achieved in 10 (71.4%) patients during follow-up. Ten over 11 patients (90.9%) with hypertrophic pseudarthrosis achieved union. On the other hand, none of the patients with atrophic pseudarthrosis achieved union.
Conclusion: Considering the high-dose local antibiotic effect and the advantage of stabilization with intramedullary nail, antibiotic impregnated PMMA cement-coated locked intramedullary nail application may be recommended in the treatment of hypertrophic pseudarthrosis. However, regarding the treatment of atrophic pseudarthrosis, it seems to be effective for the treatment of infection but ineffective for bone union. Larger trials are warranted.
Keywords: Antibiotic impregnated polymethylmethacrylate, intramedullary nail, non-union, chronic osteomyelitis, pseudarthrosis
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