European Journal of Cardiovascular Medicine

Introduction: The incidence of high-velocity injuries leading to open fractures has been increasing, results in more cases of nonunion and osteomyelitis. Antibiotic-impregnated polymethyl methacrylate (PMMA) coated nails or beads delivers a higher concentration of local antibiotics to treat bone infections. Our study is to assess the outcome of dual antibiotic impregnated bone cement coated nails in infected nonunions and chronic osteomyelitis of the tibia and femur. Methods: The study was conducted in two different hospitals. Cases selected based on the proposed inclusion and exclusion criteria. A combination antibiotic of 500 milligrams of Gentamicin impregnated in 40 grams of PMMA mixed with 3 grams of Vancomycin is used to coat nails with a custom-made mould. In every case, medullary canal was reamed and irrigated with saline. The antibiotic nail was placed within the medullary canal. After six weeks nail was removed and a secondary procedure was done. Time taken for wound healing /sinus tract healing, bone healing and secondary procedure were noted. Results were evaluated using the ASAMI (Association for the Study and Application of Methods of Ilizarov) scoring system. Results: the study was conducted in 27 cases with 19 males and 8 females. 16 tibias and 11 femurs are treated with excellent and good results in 20, fair and poor in six as per the ASAMI scoring system. One case with poor result required multiple procedures to eradicate the infection. Conclusion: This study shows dual antibiotic bone cement-impregnated nails are effective in treating nonunion of long bones and the use of a mould will produce nails of consistent diameters with a smooth surface that facilitates easy introduction and extraction. These nails provide relative stability to nonunion and are a substitute for expensive imported beads and nails.