Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases
Abstract Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatmen...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-020-03734-z |
| _version_ | 1828404160874151936 |
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| author | Hong-An Zhang Chun-Hao Zhou Xiang-Qing Meng Jia Fang Cheng-He Qin |
| author_facet | Hong-An Zhang Chun-Hao Zhou Xiang-Qing Meng Jia Fang Cheng-He Qin |
| author_sort | Hong-An Zhang |
| collection | DOAJ |
| description | Abstract Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing. |
| first_indexed | 2024-12-10T10:31:44Z |
| format | Article |
| id | doaj.art-ea1523188a9d44a6b01cf062ff49e69d |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-10T10:31:44Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-ea1523188a9d44a6b01cf062ff49e69d2022-12-22T01:52:33ZengBMCBMC Musculoskeletal Disorders1471-24742020-10-0121111010.1186/s12891-020-03734-zIntramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 casesHong-An Zhang0Chun-Hao Zhou1Xiang-Qing Meng2Jia Fang3Cheng-He Qin4Department of Orthopaedics and Traumatology, Guangdong second provincial general hospital, The Second Clinical Medical School of Southern Medical UniversityDepartment of Orthopaedics, Nanfang Hospital, Division of Orthopaedics and traumatology, Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Guangdong second provincial general hospital, The Second Clinical Medical School of Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Guangdong second provincial general hospital, The Second Clinical Medical School of Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Guangdong second provincial general hospital, The Second Clinical Medical School of Southern Medical UniversityAbstract Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.http://link.springer.com/article/10.1186/s12891-020-03734-zDebridementFracture-related infectionIntramedullary nailingLocal antibiotic deliveryReaming |
| spellingShingle | Hong-An Zhang Chun-Hao Zhou Xiang-Qing Meng Jia Fang Cheng-He Qin Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases BMC Musculoskeletal Disorders Debridement Fracture-related infection Intramedullary nailing Local antibiotic delivery Reaming |
| title | Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases |
| title_full | Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases |
| title_fullStr | Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases |
| title_full_unstemmed | Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases |
| title_short | Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases |
| title_sort | intramedullary reaming and irrigation and antibiotic loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing a retrospective study of 19 cases |
| topic | Debridement Fracture-related infection Intramedullary nailing Local antibiotic delivery Reaming |
| url | http://link.springer.com/article/10.1186/s12891-020-03734-z |
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