Raschke M, Vordemvenne T, Fuchs T
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
Eur J Trauma Emerg Surg. 2010 Dec;36(6):605-8. doi: 10.1007/s00068-010-0017-x. Epub 2010 Apr 20.
Severe grade IIIc tibial fractures have limited treatment options. The decision between limb salvage or amputation depends on many factors, including the age and health status of the patient, as well as the soft tissue status and associated injuries. Until recently, intramedullary nailing was not a favoured treatment option in such tibial fractures, since it is associated with an increased risk of deep wound infections and osteomyelitis.
Here we present a case where a novel polylactic acid/gentamicin coated unreamed tibial nail (UTN-PROtect(®)) has been used to successfully salvage the limb of a 17-year-old man, where prolonged external fixation or amputation would have been the standard treatment.
This case demonstrates that treating severe grade IIIc tibial fractures with the acid/gentamicin coated unreamed tibial nail (UTN-PROtect(®)) is a viable alternative to prolonged external fixation or amputation.
The gentamicin-loaded coating of the UTN-PROtect(®) nail, which releases the antimicrobial agent directly at the bone-implant inter-face, overcomes the limitation of insufficient antibiotic delivery. Awareness of this case and the existing literature supporting the use of an antibiotic coated nail may assist surgeons in their decisions on how to treat severe grade IIIc fractures.
严重的IIIc级胫骨骨折治疗选择有限。保肢还是截肢的决定取决于许多因素，包括患者的年龄和健康状况，以及软组织状况和相关损伤。直到最近，髓内钉固定在这类胫骨骨折中还不是一种受欢迎的治疗选择，因为它会增加深部伤口感染和骨髓炎的风险。
在此，我们报告一例使用新型聚乳酸/庆大霉素涂层非扩髓胫骨钉（UTN-PROtect(®)）成功挽救一名17岁男性肢体的病例，在该病例中，延长外固定或截肢本应是标准治疗方法。
该病例表明，用聚乳酸/庆大霉素涂层非扩髓胫骨钉（UTN-PROtect(®)）治疗严重的IIIc级胫骨骨折是延长外固定或截肢的一种可行替代方案。
UTN-PROtect(®)钉的庆大霉素负载涂层可在骨-植入物界面直接释放抗菌剂，克服了抗生素递送不足的局限性。了解该病例以及支持使用抗生素涂层钉的现有文献可能有助于外科医生决定如何治疗严重的IIIc级骨折。
