An alternative management option for infected non-union of long bone fractures

Management of infected non-union following fracture of a long bone is a challenge to the orthopaedic surgeon. Several methods of treating these cases have been described.(1-7) Although reports of single stage or multiple stage procedures exist in the literature, general consensus appears to favour a two-stage approach with initial debridement followed by the use of local antibiotic cement in the first stage.(2,5,8) This antibiotic-impregnated cement has been reported in previous papers as placed around an intramedullary nail or via antibiotic cement beads,(4-6,9) Cement beads offer no mechanical stability to the fracture site. Placing cement around an intramedullary device provides added concerns, such as cement nail debonding and the continued presence of metal, which could cause persistence of infection when in contact with endosteal sequestrate. We describe the use of an antibiotic cement nail fashioned by hand intra-operatively around a length of nylon tape. This eliminates the need for further metalwork during the infected stage, thereby reducing the chance of persistent non-union as well as providing some stability across the fracture site.