Standardized debridement for the management of fracture-related infection after intramedullary nailing: A retrospective single-center cohort study of 69 patients

The aim of this study was to evaluate the clinical efficacy of a standardized debridement for the management of fracture-related infection (FRI) following intramedullary nailing. We conducted a retrospective analysis of clinical data from patients who developed FRI after intramedullary nailing at our hospital between February 2013 and April 2020. Most patients involved a 2-stage surgical approach utilizing the induced membrane technique (induced membrane group). In the first stage, the intramedullary nail was removed, and standardized debridement was performed. The resulting bone defects were stabilized with plate and filled with antibiotic-loaded cement. In the second stage, bone grafting was performed to repair the defects. A control group, patients who did not undergo bone grafting was used for comparison. Clinical outcomes, including infection control and bone defect union, were monitored. Infection control rates and complications were compared between the 2 groups. A total of 69 patients were enrolled, including 37 tibias and 32 femurs. After the mean follow-up of 38.8 months, the primary infection control rate was 79.7% (55/69), the final infection control rate and complication rate were 97.1% (67/69) and 17.4% (12/69), respectively. In the induced membrane group, the primary infection control rate was 87.0% (40/46), and increased to 100% after repeated debridement. No infection recurrence occurred after the second-stage bone grafting. The bone union rate was 97.8% (45/46). Recurrent infection occurred in 6 patients, which was significantly lower than 8 cases in the control group (P = .038). There was no significant difference in the final infection control rate(100% vs 91.3%, P = .108) and complication rate (15.2% vs 21.7%, P = .360) between the 2 groups. The standardized debridement protocol represents an effective strategy for managing FRI following intramedullary nailing, with high infection control rate and bone union rate, especially to the patients with bone defect after debridement.