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Osteosynthesis and Trauma Care 2004; 12(2): 62-67
DOI: 10.1055/s-2004-822687
Original Article

© Georg Thieme Verlag Stuttgart · New York

Infection after Tibial Intramedullary Nailing: Diagnosis and Treatment

G. A. Zych1
  • 1Department of Orthopedics and Rehabilitation, University of Miami School of Medicine, Miami, FL, USA
Further Information

Publication History

Publication Date:
05 July 2004 (online)

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Abstract

Infection after tibial intramedullary nailing is a recognized complication in the management of fractures and reconstructive procedures. The highest incidence occurs with reamed nailing of open tibial fractures. Substance abuse (tobacco, alcohol, drugs) is noted in many patients. The diagnosis is made on the basis of history and physical examination supplemented with plain radiographs. Wound cultures will usually yield the causative organism, most commonly, Staphylococcus aureus. Treatment relies upon following established surgical principles of abscess drainage, soft tissue and bone debridement, maintenance of osseous stability and appropriate antimicrobial therapy. Complete eradication of infection often requires eventual removal of the nail implant. The functional outcome is highly satisfactory in the majority of cases.

Key words

Tibial infection - intramedullary nailing - external fixation - reaming

References

  • 1 Court-Brown C M, Keating J F, McQueen M M. Infection after intramedullary nailing of the tibia. Incidence and protocol for management.  J Bone Joint Surg [Br]. 1992;  74 770-774
    PubMedGoogle Scholar
  • 2 Gursel I, Korkusuz F, Turesin F, Alaeddinoglu N G, Hasirci V. In vivo application of biodegradable controlled antibiotic release systems for the treatment of implant-related osteomyelitis.  Biomaterials. 2001;  1 73-80
    PubMedGoogle Scholar
  • 3 Hempel D, Fischer S. Intramedullary Nailing. Thieme-Stratton Inc., New York 1982; 128
    Google Scholar
  • 4 Inada A, Imaizumi T, Uemura M. Treatment for postoperative osteomyelitis with antibiotics polymethylmethacrylate nail.  Rinshou Seiki Geka. 2000;  35 349-351
    PubMedGoogle Scholar
  • 5 Klemm K W. Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail.  Clin Orthop. 1986;  212 174-181
    PubMedGoogle Scholar
  • 6 Kruger-Franke M, Carl C, Haus J. Treatment of infection following intramedullary nailing. A comparison of various treatment regimens.  Akt Traumatol. 1993;  23 72-76
    PubMedGoogle Scholar
  • 7 Lidgren L, Onnerfalt R. Infected non-union of the tibial shaft treated by Küntscher intramedullary reaming and nail fixation. A report of four cases.  Acta Orthop Scand. 1982;  53 669-674
    PubMedGoogle Scholar
  • 8 Lusser G M, Muller J. Plate fixation and open wound treatment in infected intramedullary nails.  Helv Chir Acta. 1978;  45 595-602
    PubMedGoogle Scholar
  • 9 Malamitsi J, Giamarellou H, Kanellakopoulou K, Dounis E, Grecka V, Christakopoulos J, Koratzanis G, Antoniadou A, Panoutsopoulos G, Batsakis C, Proukakis C. Infecton: a 99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection.  Clinical Microbial Infect. 2003;  9 101-109
    PubMedGoogle Scholar
  • 10 Melcher G A, Metzdorf A, Schlegel U, Ziegler W J, Perren S M, Printzen G. Influence of reaming versus nonreaming in intramedullary nailing on local infection rate: Experimental investigation in rabbits.  J Trauma. 1995;  39 1123-1128
    PubMedGoogle Scholar
  • 11 Miller M E, Ada J R, Webb L X. Treatment of infected nonunion and delayed union of tibia fractures with locking intramedullary nails.  Clin Orthop. 1989;  245 233-238
    PubMedGoogle Scholar
  • 12 Ohtsuka H, Yokoyama K, Higashi K, Tsutsumi A, Fukushima N, Noumi T, Itoman M. Use of antibiotic-impregnated bone cement nail to treat septic nonunion after open tibial fracture.  J Trauma. 2002;  52 364-366
    PubMedGoogle Scholar
  • 13 Paley D, Herzenberg J E. Intramedullary infections treated with antibiotic cement rods: Preliminary results in nine cases.  J Orthop Trauma. 2002;  16 723-729
    CrossrefPubMedGoogle Scholar
  • 14 Patzakis M J, Wilkins J, Wiss D A. Infection following intramedullary nailing of long bones: Diagnosis and management.  Clin Orthop. 1986;  212 182-191
    PubMedGoogle Scholar
  • 15 Pavoni G L, Falcone M, Baiocchi P, Tarasi A, Cassone M, Serra P, Venditti M. Conservative medical therapy of infections following osteosynthesis: a retrospective analysis of a six-year experience.  J Chemother. 2002;  14 378-383
    PubMedGoogle Scholar
  • 16 Pommer A, David A, Richter J, Muhr G. Intramedullary reaming in infected intramedullary nails of the tibia and femur.  Unfallchirurg. 1998;  101 628-633
    CrossrefPubMedGoogle Scholar
  • 17 Riemer B L, Butterfield S L. Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: A preliminary report.  J Orthop Trauma. 1993;  7 279-285
    PubMedGoogle Scholar
  • 18 Riemer B L, DiChristina D G, Cooper A, Sagiv S, Butterfield S L, Burke C J, Lucke J F, Schlosser J D. Nonreamed nailing of tibial diaphyseal fractures in blunt polytrauma patients.  J Orthop Trauma. 1995;  9 66-75
    PubMedGoogle Scholar
  • 19 Rutledge B, Huyette D, Day D, Anglen J. Treatment of osteomyelitis with local antibiotics delivered via bioabsorbable polymer.  Clin Ortho. 2003;  411 280-287
    PubMedGoogle Scholar
  • 20 Schmit-Neurerberg K P. Course and treatment of infections after intramedullary osteosynthesis. In: Maatz R, Lentz W, Arens W, Beck H (eds). Intramedullary Nailing and Other Intramedullary Osteosyntheses. Saunders/Schattauer, Philadelphia 1986; 161-170
    Google Scholar
  • 21 Sledge S L, Johnson K D, Henley M B, Watson J T. Intramedullary nailing with reaming to treat non-union of the tibia.  J Bone Joint Surg [Am]. 1989;  71 1004-1019
    PubMedGoogle Scholar
  • 22 Tornetta P, DeMarco C. Intramedullary nailing after external fixation of the tibia.  Bull Hosp Jt Dis. 1995;  54 5-13
    PubMedGoogle Scholar
  • 23 Ueng W N, Shih C H. Management of infected tibial intramedullary nailing using an organized treatment protocol.  J Formos Med Assoc. 1992;  91 879-885
    PubMedGoogle Scholar
  • 24 Yokoyoma K, Shindo M, Itoman M, Yamamoto M, Sasamoto N. Immediate internal fixation for open fractures of the long bones of the upper and lower extremities.  J Trauma. 1994;  37 230-236
    PubMedGoogle Scholar
  • 25 Zych G A, Hutson J J. Diagnosis and management of infection after tibial intramedullary nailing.  Clin Orthop. 1995;  315 153-162
    PubMedGoogle Scholar

Gregory A. ZychDO 

Department of Orthopedics and Rehabilitation · University of Miami School of Medicine

P.O. Box 01 69 60 (D-27)

Miami, FL 33101

USA

Phone: +1/3 05-5 85-71 48

Fax: +1/3 05-3 24-76 58

Email: Gzych@Med.Miami.Edu

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