Locked Plate Impregnated with Antibiotic-Loaded Bone Cement Application as a First Stage For Managing Long Bones Infected Nonunion: A Technical Note

Background. Infected nonunion of long bone fractures poses a dilemma for trauma surgeons, especially when accompanied by bone defects. The main goals for management are curing infection, reconstructing the bone defect, achieving union at the fracture site, and eventually obtaining acceptable functional outcomes. In these situations, the surgeon could manage the infected nonunion through single-stage surgery. However, some surgeons prefer two-stage surgical intervention, wherein in the first stage, all attention is paid to curing the infection and providing temporary stabilization till the second stage, which is the definitive fixation. Temporary fixation during the first stage after thorough debridement could be obtained by various methods, including intramedullary nails coated by bone cement or external fixators. The aim — to describe a modification while using a locked plate impregnated with antibiotic-loaded bone cement during the first stage of two-stage revision for managing infected nonunited distal femoral fracture. Technique description. The method described in the current technical note is a locking plate impregnated with antibiotic-loaded bone cement. This technique provides optimal local antibiotic delivery through the bone cement and proper stability owing to the fixation using the locking plate, which could be applied as close to the bone as possible due to its function as an internal-external fixator. Conclusion. The technique is easy and efficient and can be applied using ordinary tools without needing complex instruments.