Antibiotic cement screw for postoperative infection after gamma nailing

Few articles describe the management of postoperative infection occurring after the use of an intramedullary nail in the treatment of femoral intertrochanteric fractures. Implant removal is frequently selected for postoperative infection control, especially in chronic cases. However, removal of the intramedullary nail causes a high rate of femoral neck fractures, challenging surgeons to prevent such fractures with few guidelines for how this can be done. This article presents 2 cases of postoperative infection following intramedullary nail implant in elderly women. After removal of the infected implant and meticulous debridement, an antibiotic cement screw (a cannulated screw enveloped with antibiotic-impregnated bone cement) was inserted from the lag screw hole into the femoral head. At the latest follow-up (mean, 18 months postoperatively), neither femoral neck fracture nor infection had occurred in either patient. The antibiotic cement screw is expected to provide stability and prevent fracture at the femoral neck region, and its more intimate contact with the medullary canal allows a higher concentration of local antibiotics than intravenous application. The antibiotic cement screw is recommended especially for infection after gamma nailing. We also introduce a simple, reproducible method for constructing an antibiotic cement screw large enough to fit the lag screw hole using bone cement, cannulated screw, antibiotics, and a chest tube.