2023, Vol. 27 ›› Issue (7): 1023-1030

Antibiotic bone cement intramedullary nail prepared using 3D printed mold for the treatment of long bone infection in lower limbs

Zhao Wei, Feng Wei, Yang Tieyi, Ren Wei, Wang Yuxin, Lyu Huicheng, Chang Zhiqiang, Feng Xiaodong, Wang Ziheng, Guo Shibing   

Abstract: BACKGROUND: Due to many problems in the preparation technology and intraoperative operation of antibiotic cement rods or nails, their applications are still limited.
OBJECTIVE: To explore the clinical effect of antibiotic bone cement intramedullary nail implantation prepared using 3D printed molds combined with debridement in the treatment of postoperative infection in the lower extremities long bone infection.
METHODS: From October 2018 to October 2020, 16 patients with femoral and tibial infection were treated by antibiotic bone cement intramedullary nail medullary cavity implantation made of 3D printed mold. There were 10 cases of femur and 6 cases of tibia. According to Cierny Mader’s classification of bone infection, there were 4 cases of type III, 7 cases of type I + type III, and 5 cases of type I + type IV. The time from the first (surgical) treatment to the initial infection was 0.5-120 months and the duration of infection was 0.5-118 months. In the intramedullary nail fixation group, the soft tissue scar, granulation tissue and dead bone at the infected fracture end and the interlocking screw were completely removed after the removal of intramedullary nail. The soft tissue involved in infection was removed for patients with sinuses and soft tissue abscesses. The necrotic and inflammatory tissues in the medullary cavity were removed with soft drill and examined. Antibiotic bone cement intramedullary nail was implanted after repeated irrigation of the medullary cavity. In the non-intramedullary nail fixation or non-fixation group, the infected broken end or focal infection site was cut open. The sinuses and infected soft tissue were removed together. The pulp was expanded according to the standard procedures of femoral or tibial intramedullary nail fixation. The other procedures were the same as before.
RESULTS AND CONCLUSION: (1) All patients were followed up for 12-24 months. There was no recurrence of infection or complications. (2) One case was infected with malunion of fracture. The range of motion of the knee joint was 50 degrees in a patient with femoral fracture. (3) Bacterial culture and histological examination of intramedullary tissue obtained from six patients with bone cement nail removal were all negative. (4) The hospital stay of all patients was 7-53 months. The medical expenses ranged from 6 000 to 49 400 yuan. (5) It is concluded that a medullary debridement in combination with antibiotic bone cement intramedullary nail implantation is an effective treatment for long bone infection. The application of this technique in the treatment of lower limb long bone infection can shorten the operation time and greatly reduce the medical cost. Level of evidence: therapeutic research level IV.
Key words: femur, tibia, fracture associated infection, osteomyelitis, intramedullary infection, antibiotic bone cement