Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods

Background: Intramedullary nailing is widely accepted as the gold standard for most metaphyseal fractures of the long bones. Infections after intramedullary nailing have increased and cause recalcitrant metaphyseal osteomyelitis. Usually, multiple surgeries combined with adjuvant administration of local and systemic antibiotics are required to achieve infection control. The recurrence rate is still high and often causes poor limb function. Enhancement of local antibiotic concentrations through different delivery systems has been developed as an effective solution for eliminating musculoskeletal infections. Our study was conducted to evaluate the efficacy of antibiotic-loaded acrylic cement rods in managing infected intramedullary nailing. Methods: Twelve patients with metaphyseal osteomyelitis following intramedullary nailing were enrolled. The causative organisms were identified in eight patients, including six methicillin-resistant Staphylococcus aureus, one methicillin-susceptible S aureus, and one methicillin-resistant S aureus and Prevotella intermedia mixed infection. All patients were treated with radical reaming debridement, copious intramedullary lavage, insertion of an impregnated acrylic cement rod, and systemic antibiotic administration. Results: The average follow-up duration was 59.1 months. None of the 12 patients showed a relapse of infections. Four patients had nonunion of the old fracture site and received subsequent revisional internal fixation and bone grafting. All of them achieved solid bony union within 18 weeks. Conclusions: Insertion of antibiotic-loaded acrylic cement rods combined with adequate debridement, lavage, and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.