Evaluation of Clinical and Radiological Outcomes in Open Tibial Shaft Fractures Managed with A Versatile Antibiotic Intramedullary Interlocking Nailing System

ABSTRACT Background: Open tibial shaft fractures are challenging injuries because of soft-tissue compromise and the risk of fracture-related infection (FRI). Antibiotic-coated intramedullary devices have been investigated as a way to combine fracture stabilization with local antimicrobial delivery; the available evidence remains heterogeneous and does not establish superiority for every fracture pattern or device. Objective: To describe clinical and radiological outcomes in patients with open tibia–fibula fractures treated with the Versatile Antibiotic Intramedullary Interlocking (VAIL) system. Methods: This prospective observational study was reported as having enrolled 50 patients with Gustilo–Anderson grade II, IIIA, or IIIB open fractures between 2024 and 2026. The nail was coated with polymethylmethacrylate (PMMA) cement containing vancomycin and gentamicin. Outcomes reported in the source manuscript included postoperative infection and radiographic union assessed using the Radiographic Union Scale for Tibial fractures (RUST). Results: The source dataset reports 11 postoperative infections among 50 enrolled patients (22%), including six superficial infections (12%) and five deep infections (10%). Infection was reported in 0/14 patients operated on within 12 hours, 5/27 operated on at 13–24 hours, and 6/9 operated on after 24 hours. Forty-eight patients completed the stated 9-month follow-up. At that time point, 39/48 had RUST scores of 10–12, five had scores of 7–9, and four had scores of 6 or less. Conclusion: The series describes the use of a PMMA antibiotic-coated interlocking nail in selected open tibial fractures. Because the study has no comparator group and the source manuscript contains denominator and eligibility inconsistencies requiring author confirmation, these data should be interpreted as descriptive and do not establish that VAIL prevents infection, eliminates staged treatment, or is superior to other accepted strategies. Keywords: open tibial fracture; fracture-related infection; antibiotic-coated nail; PMMA; intramedullary interlocking nail; RUST.