Antibiotic Cement-Coated Nails for the Treatment of Infected Nonunions and Segmental Bone Defects

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Abstract
Treatment of infected nonunions is a challenge faced by many orthopaedic surgeons. Traditionally, the treatment strategy has been control of the infection followed by procedures to achieve osseous union. Débridement, antibiotic-impregnated cement beads, and intravenous antibiotics have been used for the control of the infection1-3. External or internal fixation methods have been used to achieve stability to promote union. Antibiotic cement-coated intramedullary nails can be used to treat the infection with high doses of local antibiotics and to provide bone stability4. Use of these devices allows immediate weight-bearing and prevents many complications associated with external fixation, such as pin-track infections and joint stiffness. This novel approach to the treatment of infected nonunions was developed to minimize the number of additional surgical procedures required for infection control and to achieve bone union. We present our series of fifty-two patients in whom an antibiotic cement-coated intramedullary nail was inserted for the treatment of an infected nonunion or segmental bone defect. ### Preoperative Planning Careful preoperative planning is essential. It is essential to determine if the patient has a history of allergy to antibiotics so that those antibiotics are not used when mixing the bone cement. The evaluation of intraoperative culture and sensitivity results guides the selection of the appropriate postoperative intravenous antibiotics. Preoperative radiographs, including anteroposterior and lateral views of the involved bone and full-length standing anteroposterior views of both lower extremities made with a 130-cm cassette, should be evaluated. This evaluation allows the surgeon to determine the size of the intramedullary nail that should be used and also provides information regarding the need for additional procedures (such as deformity correction). The length of the intramedullary nail is determined with the same standard method as is used to determine the length of an interlocking nail. For example, when antegrade …

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