Internal nail with resorbable calcium sulfate may address limb reconstruction pathologies
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.
“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.”