A Definitive Role of Antibiotic Impregnated Nailing in Compound Fractures of Tibia

Introduction: Antibiotic nails are currently the preferred treatment for Gustilo Type I, II, and IIIA fractures, replacing the conventional approach of fixing open tibia fractures. They not only expedite the one-step bone union process but also lessen the systemic adverse effects of parenteral antibiotics after surgery. These nails elute the antibiotic exactly in the right doses where it is needed to combat the infection and prevent a possible delayed union or hostile environment in Gustilo type I, II and IIIA compound tibial fractures.

Aim: The aim was to determine the definitive role of antibiotic-impregnated Intramedullary (IM) nailing in compound tibial fractures.

Materials and Methods: We treated twenty-five adults having compound tibial shaft fractures of Gustilo Type I and Type II and IIIA with antibiotic-impregnated IM nails to evaluate the outcome.

Results: Results were excellent to good in 92% (Lysholm’s scale). Partial weight bearing commenced at 5.44 weeks and full weight bearing after 10.48 weeks of operation on average. Radiological union achieved in 12 to 18 weeks (average 15.55 weeks) in all AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) group A, group B fractures with Gustilo type I injury. Complex (AO group C), while Gustilo type II took 12 to 22 weeks (average 16.69 weeks). One Gustilo type IIIA fracture showed delayed union (beyond 22 weeks). There was minimal incidence of infection [overall 24% (20% in type II- superficial in 12% and deep in 8% cases; 4% in type IIIA-deep)]. One Gustilo type IIIA fracture showed infection along the deeper tissue planes. In the present study, results were better when compared with the above-quoted studies as 100% union was achieved with an overall infection rate of 24% only. The infection did not hinder the union and resolved with a local antibiotic release through nail and concurrent administration of systemic antibiotics.

Conclusion: Antibiotic-impregnated nails can be a trustworthy alternative single-stage treatment modality, obviating the need for multiple procedures to achieve the bony union in open fractures of the tibia. Early range of motion exercises of joints and early weight bearing are permitted because breakage of the implant is very uncommon due to load sharing.