Antibiotic-Coated Interlocking Intramedullary Nail for the Treatment of Long-Bone Osteomyelitis
Osteomyelitis is a serious complication of orthopaedic injuries and interventions. Although routine perioperative antibiotic administration has been effective in reducing rates of infection following orthopaedic surgery1, surgical-site infections occur in 0.7% to 4.2% of patients undergoing elective procedures2,3 and in 5% to 33% of patients with open fractures4-7. Thorough debridement of necrotic bone, large-volume irrigation, and systemic antibiotics are cornerstones of therapy. These infections frequently involve gram-positive skin flora, particularly Staphylococcus epidermidis and Staphylococcus aureus, which produce biofilms on the surface of orthopaedic implants, thus precluding their eradication without removal of the colonized implant. Unfortunately, systemic antibiotics may not achieve effective local concentrations in tissue that has been damaged by trauma or otherwise compromised8, a problem compounded by the fact that implant removal and osseous debridement produce a dead space that is relatively inaccessible to systemic antibiotics and the immune system9.