Artisanal Centromedullary Nail Coated with Targeted Antibiotic-Impregnated Cement - Treatment of Diaphyseal Septic, Malaligned Non-Union of the Tibia and Femur

Abstract Background: Artisanal coated intramedullary standard nails with a layer of antibiotic cement were used in osteosynthesis of the tibia or femur that had septic non-unions: case report series. Objectives: To cure the septic nonunion and malalignment with cement-antibiotic-coated crafted nails in septic diaphyseal nonunion of the tibia and femur. Methods: We operated on 24 cases with tibial or femoral septic non-union. Eight cases had severe malalignment (10 degrees-30 degrees). After debridement and reaming of the bone in excess by 4 mm thicker than the desired nail diameter, we performed the synthesis with cemented nails. We manually coated the intramedullary standard nails with a layer of antibiotic cement, efficient against the patient's germs. In the cement, in 18 cases we added Vancomycin 2 g / dose, and in 6 cases we used standard Erythromycin and Gentamicin cement. In 22 cases we were able to lock the cemented crafted nail. Results: Healing of the nonunion was achieved in all cases, and restoration of alignment was obtained in 23 cases. In 8 cases we have added hydroxyapatite locally preloaded with tobramycin. Clinical and laboratory criteria confirmed the absence of sepsis. We were confident to extract the implant in only 14 cases. Conclusions: Good results have been obtained with these cement-antibiotic-coated crafted nails in septic diaphyseal non-union of the tibia and femur. Malalignment, sepsis, and non-union are all resolved by the one-step procedure. Our experience is limited, but in the future, it could be a valuable method. Keywords: Septic non-union; Tibia; Femur; Antibiotic cement artisanal nail; Malalignement