Emerging Data

Emerging Data

Disclosures: Fragoman reports he is a consultant for DePuy Synthes, NuVasive Inc., Smith & Nephew and Globus Medical.
April 30, 2021
1 min read
Save

Internal nail with resorbable calcium sulfate may address limb reconstruction pathologies

Disclosures: Fragoman reports he is a consultant for DePuy Synthes, NuVasive Inc., Smith & Nephew and Globus Medical.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Published results showed limb reconstruction with internal lengthening nails and antibiotic-loaded resorbable calcium sulfate may address infectious and length pathologies while avoiding the disadvantages of prolonged external fixation.

Austin T. Fragomen, MD, and colleagues identified 11 patients who underwent intramedullary or osteotomy site treatment with antibiotic-loaded resorbable calcium sulfate (Stimulan, Biocomposites Inc.) and placement of a magnetic internal lengthening nail (Precice system, NuVasive Inc.) for either lengthening (n=7) or compression at the nonunion site (n=4). Researchers diagnosed eight patients with nonunion, while three patients had post-traumatic or post-infectious bone loss resulting in a history of osteomyelitis and four patients had a risk of or concern for intramedullary infection due to prior external fixation or recalcitrant nonunion.

Results showed nail placement proceeded without difficulty in nine cases, while two cases required re-reaming after hardening of the antibiotic-loaded resorbable calcium sulfate. Researchers found two of the seven patients who underwent lengthening achieved lengthening within 0.2 cm of the goal of 3.9 cm and five of seven patients achieved goal length. All patients who required nonunion compression achieved compression goals, according to results. Researchers noted the magnetic internal lengthening nail functioned without impediment by the antibiotic-loaded resorbable calcium sulfate in all cases, and no patients experienced intraoperative or perioperative pulmonary complications from the canal instrumentation.

Austin T. Fragomen
Austin T. Fragomen

“The take-home message of this study is that internal implants can be used to treat bone fractures in the presence of infection if coated with antibiotics, and the use of antibiotic paste can prevent infection in high-risk surgeries,” Fragomen, a limb lengthening and reconstruction orthopedic surgeon at Hospital for Special Surgery, told Healio Orthopedics. “The deeper message is one of the power of collaboration for posterity. A unified effort from three major orthopedic centers has produced a mini-consensus supporting this novel technique for infection control.”