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Advantage of antibiotic cement-coated interlocking intramedullary nail (tibia nail/femur nail) over conventionally used antibiotic cement-coated Kuntscher nail in infected nonunion

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Original Article

Author Details : Gautam Chand, Vinod Kumar Gauttam*, Shiv Bhagwan Sharma, S C Vijiyavergiya

Volume : 6, Issue : 3, Year : 2020

Article Page : 247-253

https://doi.org/10.18231/j.ijos.2020.046

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Abstract

Background: Open fracture are very prone to chronic infection. The infection of long bones during its
process of fracture healing not only delay but may completely abort the fracture healing and leads to
nonunion. Infection along with its nonunion is very difficult to treat and a debilitating disorder which
bother both the patients and surgeon. However in many studies, this situation is usually managed with
multiple steps first to cure the infection before dealing with nonunion. But this is a single step procedure
to cure both infection and nonunion simultaneously with intramedullary nail that coated with antibiotic
cement. It is difficult to achieves axial and rotational stability along with controlling infection by antibiotic
cement-coated Kuntscher nail. This study we have compare the outcome in term of control the infection and
treating nonunion and copmplication associated with these. And also the advantage of antibiotic cementcoated
interlocking intramedullary nail (tibia nail / femur nail) for achieving good stability.
Materials and Methods: In our study we included 20 adult patients all have stablisted infective nonunion
and divided into two group according to types of intramedullary nail used. In group A 12 adult patients
with infective nonunion of tibia & femur (9 tibia and 3 femur) were managed using antibiotic cementcoated
interlocking intramedullary nail (group A)(tibia nail / femure nail) with proximal and distal locking
screws. And in group B 8 adult patients with stablised infective nonunion of tibia & femur (7 tibia and
1 femur) were treated using antibiotic cement-coated K-nail. Combination of Antibiotics used are 4gm
vancomycin and 3gm clindamycin in 40gm bone cement package.
Results: Controlled of infection is 90% (18 out of 20 patients) similar in both. Bony union achieved in
83% (10 out of 12 patients) in group A with average time of union is 6 months. Bony union 62.5% (5 out of
8 patients) in group B with average time of union 8 months. The additional procedures in remaining were
done as bone grafting, bone marrow infiltration and exchange nailing. Persistence of infection still present
in 2 patients. All these patients are followed-up was up to 1 year.
Conclusion: Using of Antibiotic-cement coated interlocking intramedullary nail (tibia nail / femure nail)
with locking screws is a simple, economical, and effective single-stage procedure for the management of
infected nonunion of the long bones. It has many advantages over conventional antibiotic cement-coated
Kuntscher nail, as it eliminates the complications and has good patient compliance. The method can be
performed at any hospital with existing easily available instrumentation and is technically less demanding.

Keywords: ACIIN, Antbiotic coated nailing, Infected non union.

How to cite : Chand G , Gauttam V K , Sharma S B , Vijiyavergiya S C , Advantage of antibiotic cement-coated interlocking intramedullary nail (tibia nail/femur nail) over conventionally used antibiotic cement-coated Kuntscher nail in infected nonunion. Indian J Orthop Surg 2020;6(3):247-253

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