Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy.
Orthopedics and Traumatology, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
Biomed Res Int. 2021 Oct 14;2021:7421582. doi: 10.1155/2021/7421582. eCollection 2021.
Implant-associated infections remain one of the main problems in the treatment of open tibia fractures. The role of systemic antibiotic prophylaxis is now agreed and accepted; nevertheless, recent literature also seems to emphasize the importance of local antibiotic therapy at the fracture site. Several therapeutic strategies have been proposed to overcome this new need. Antibiotic-coated nails play crucial role in this, allowing both infection prevention and favoring the fracture stabilization. We describe the outcome of patients with open diaphyseal tibia fracture treated either with a standard uncoated nail or a gentamicin-coated nail from January 2016 to December 2018 at our second level emergency-urgency department. Primary outcomes were infection rate and bone union rate. Other outcomes reported are reoperation rate, time between injury and nailing, and safety of antibiotic nail. Numerical variables were tabulated using mean, standard deviation, minimum, maximum, and number of observations. Categorical variables were tabulated using number of observations. 23 patients treated with uncoated nail and 23 patients treated with antibiotic-coated tibia nail were included in the study and were evaluated for a minimum follow-up of 18 months. Among the 46 patients, 9 were Gustilo-Anderson type I, 21 type II, and 16 type III open fracture. Regarding the bone healing rate at 12 months, 16 fractures in the first group and 18 in the second were completely healed. 4 infections were found in the first group (3 superficial surgical site infection and 1 osteomyelitis) and 3 superficial infections in the second one. No adverse events have been recorded with antibiotic-coated nails. In this unicentric retrospective study observed no deep wound infections and good fracture healing in the use of antibiotic-coated nails. Antibiotic nails have been shown to play a role in the treatment of fractures in critically ill patients with severe soft tissue damage.
植入物相关感染仍然是开放性胫骨骨折治疗的主要问题之一。全身抗生素预防的作用现在已经得到认可；然而，最近的文献似乎也强调了在骨折部位局部使用抗生素治疗的重要性。为了满足这一新需求，已经提出了几种治疗策略。抗生素涂层钉在这方面起着至关重要的作用，既能预防感染，又能促进骨折稳定。我们描述了 2016 年 1 月至 2018 年 12 月在我们的二级急救部门接受标准未涂层钉或庆大霉素涂层钉治疗的开放性骨干胫骨骨折患者的治疗结果。主要结果是感染率和骨愈合率。其他报告的结果是再手术率、受伤至钉扎时间和抗生素钉的安全性。数值变量用平均值、标准差、最小值、最大值和观察数进行列表。分类变量用观察数列表。研究纳入了 23 例接受未涂层钉治疗和 23 例接受抗生素涂层胫骨钉治疗的患者，随访时间至少为 18 个月。在 46 例患者中，9 例为 Gustilo-Anderson Ⅰ型，21 例为Ⅱ型，16 例为Ⅲ型开放性骨折。在 12 个月时的骨愈合率方面，第一组中有 16 例骨折完全愈合，第二组中有 18 例愈合。第一组发现 4 例感染（3 例浅表手术部位感染和 1 例骨髓炎），第二组发现 3 例浅表感染。未记录到抗生素涂层钉的不良事件。在这项单中心回顾性研究中，观察到使用抗生素涂层钉治疗严重软组织损伤的危重症患者时，深部伤口感染率低，骨折愈合良好。抗生素钉在治疗严重软组织损伤的危重症患者的骨折方面发挥了作用。
