Secondary interlocking nailing of previously infected nonunion of the tibia

Secondary interlocking nailing was performed in a series of 25 cases of uninfected, but previously infected nonunion of the tibia because of delayed bone consolidation or persisting nonunion. The primary treatment for the originally infected nonunion consisted of radical debridement, removal of alloplastic implants and sequestrated bone fragments, implantation of Gentamicin-PMMA chains(1) for local antibiotic therapy, re-osteosyenthesis with an external fixator. Bone grafting was performed after eradication of the infection. In two patients free muscle transfer with microvascular anastomosis became necessary to improve the soft tissue situation before bone grafting. Gentamicin-PMMA sticks with antibiotic activity similar to the Gentamicin-PMMA chains were inserted into the lumen of the nails as a prophylactic measure to prevent reinfection after nailing.

In 22 patients complete bone consolidation was achieved without recurrence of infection. In two patients with late recurrence of infection but incomplete bone consolidation, the implant was removed and an orthopaedic brace was applied temporarily. In one patient with early recurrence of infection with a highly resistant strain of Staph. aur. removal of the nail became necessary, followed by re-osteosyenthesis with an external fixator, systemic antibiotic therapy and secondary bone grafting.