Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2020 Vol. 28 No 6

TRAUMATOLOGY AND ORTHOPEDICS

DOI: https://dx.doi.org/10.18484/2305-0047.2020.6.680   |  

P.A. VOLOTOVSKI 1, .. SITNIK 1, D.V. TAPALSKI 2, .. YARMOLENKO 3, .. KORZUN 1, O.N. BONDAREV 1, .. GERASIMENKO 1

CLINICAL APPLICATION OF IMMEDIATE RESULTS OF CLOSED INTRAMEDULLARY NAILING WITH THREE-COMPONENT ANTIBACTERIAL COATING IN INFECTED FRACTURES AND NONUNION OF LONG TUBULAR BONES

Republican Research and Practical Center of Traumatology and Orthopedics 1, Minsk,
Gomel State Medical University 2,
Francisk Skorina Gomel State University 3, Gomel,
The Republic of Belarus

Objective. The prospective study was performed to evaluate the efficacy and safety of osteosynthesis by closed intramedullary nailing with antibacterial coating in infected fractures and nonunions of the lower extremity long tubular bones.
Methods. The study included patients (n=8) with infected fractures and nonunions of the tibia and femur. Solid titanium nails (with holes for blocking ) were used as implants. Plasma spray coating method (from the active gas phase) was used for the required thickness coating. The technique of surgical intervention included two main components: debridement of the infection site and the insertion of the nail into the medullary canal. After surgery, all patients received antibiotics based on the microbiological study. Follow-up visits to assess the activity of the infectious process and the degree of consolidation were scheduled in 6, 12, 24 and 52 weeks.
Results. By the time of preparing this article, the mean follow-up for patients after surgery had been 4.4 1.0 months. None of the patients showed any signs of infection recurrence after surgery and completion of the course of antibiotic therapy, which indicates the effectiveness and safety of this technique. Not later than 2.5 months after the surgery, all 8 (100%) patients started full weight-bearing on the operated limb. Radiography confirmed the bone healing in 5 patients; in 3 patients X-ray shows the initial signs of fracture consolidation.
Conclusion. Intramedullary osteosynthesis with new three-component antibacterial coating allowed eradicating the infection and achieving bone healing in patients with infected fractures and non-unions of the tibia and femur. This technique is effective and its application is not associated with difficulties typical for the intraoperative preparation of antibacterial coatings.

Keywords: osteomyelitis, osteosynthesis, intramedullary nailing, antibacterial coating, infection
p. 680-687 of the original issue
References
  1. Metsemakers WJ, Reul M, Nijs S. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature. Injury. 2015 Dec;46(12):2433-37. doi: 10.1016/j.injury.2015.09.028
  2. Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury. 2011 Dec;42(12):1408-15. doi: 10.1016/j.injury.2011.10.015
  3. Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. [corrected]. Clin Orthop Relat Res. 2012 Nov;470(11):3270-74. doi: 10.1007/s11999-012-2376-6
  4. Craig J, Fuchs T, Jenks M, Fleetwood K, Franz D, Iff J, Raschke M. Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing. Int Orthop. 2014 May;38(5):1025-30. doi: 10.1007/s00264-014-2293-2
  5. Moghaddam A, Zietzschmann S, Bruckner T, Schmidmaier G. Treatment of atrophic tibia non-unions according to diamond concept: Results of one- and two-step treatment. Injury. 2015 Oct;46(Suppl 4):S39-50. doi: 10.1016/S0020-1383(15)30017-6
  6. Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma. 2007 Apr;21(4):258-68. doi: 10.1097/BOT.0b013e31803ea9e6
  7. Qiang Z, Jun PZ, Jie XJ, Hang L, Bing LJ, Cai LF. Use of antibiotic cement rod to treat intramedullary infection after nailing: preliminary study in 19 patients. Arch Orthop Trauma Surg. 2007 Dec;127(10):945-51. doi: 10.1007/s00402-007-0315-x
  8. Qi C, Rogachev AV, Tapalskii DV, Yarmolenko MA, Rogachev AA, Jiang X, Koshanskaya EV, Vorontsov AS. Nanocomposite coatings for implants protection from microbial colonization: formation features, structure, and properties. Surf Coat Tech. 2017 Apr15;315:350-58. doi: 10.1016/j.surfcoat.2017.02.066
  9. Tapalski DV, Boytsova NYu, Osipov VA, Rogachev AA, Yarmolenko MA, Rogachev AV, Marchenko LA, Butovskaya GV, Krul LP. New antibacterial coating based on the mixture of polyurethane and poly-l-lactide. Dokl Nats Akad Nauk Belarusi. 2013;57(4):89-95. https://elibrary.ru/contents.asp?id=34242641 (In Russ.)
  10. Sitnik AA. Intramedulliarnyi blokiruemyi osteosintez dlinnykh trubchatykh kostei. Obshchaia tekhnika vypolneniia, rezultaty i perspektivy. Med Zhurn. 2008;(1):121-24. https://www.bsmu.by/medicaljournal/category23/ (In Russ.)
  11. Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006 May;37 Suppl 2:S59-66. doi: 10.1016/j.injury.2006.04.010
  12. Diefenbeck M, Mückley T, Hofmann GO. Prophylaxis and treatment of implant-related infections by local application of antibiotics. Injury. 2006 May;37 Suppl 2:S95-104. doi: 10.1016/j.injury.2006.04.015
  13. Schnettler R. Surgical treatment of osteomyelitis. In: Schnettler R, Steinau HU, Adams S, editors. Septic bone and joint surgery. Thieme; 2010. p. 93-172.
  14. Fuchs T, Stange R, Schmidmaier G, Raschke MJ. The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg. 2011 Oct;131(10):1419-25. doi: 10.1007/s00402-011-1321-6
  15. Raschke M, Vordemvenne T, Fuchs T. Limb salvage or amputation? The use of a gentamicin coated nail in a severe, grade IIIc tibia fracture. Eur J Trauma Emerg Surg. 2010 Dec;36(6):605-8. doi: 10.1007/s00068-010-0017-x
Address for correspondence:
220024, Republic of Belarus,
Minsk, Leytenant Kizhevatov Str., 60-4,
Republican Research and Practical Center
of Traumatology and Orthopedics
tel. +375 17 373-59-93,
e-mail: volotovski@gmail.com,
Volotovski Pavel A.
Information about the authors:
Volotovski Pavel A., PhD, Academic Secretary, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0002-4455-035X
Sitnik Alexander A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-8903-5899
Tapalski Dzmitry V., PhD, Associate Professor, Head of the Department of Microbiology, Virology and Immunology, Gomel State Medical University, Gomel, Republic of Belarus
https://orcid.org/0000-0002-9484-7848
Yarmolenko Maxim A., DSTech, Associate Professor, the Department of Radiophysics and Electronics, Francisk Skorina Gomel State University, Gomel, Republic of Belarus
https://orcid.org/0000-0002-1283-8762
Korzun Oleg A., PhD, Leading Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-7826-5269
Bondarev Oleg N., PhD, Researcher, Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0002-5998-6711
Gerasimenko Mikhail A., MD, Professor, Head of the Republican Research and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0001-9151-0214
Contacts | ©Vitebsk State Medical University, 2007