Limb salvage or amputation? The use of a gentamicin coated nail in a severe, grade IIIc tibia fracture

Severe grade IIIc tibial fractures have limited treatment options. The decision between limb salvage or amputation depends on many factors, including the age and health status of the patient, as well as the soft tissue status and associated injuries. Until recently, intramedullary nailing was not a favoured treatment option in such tibial fractures, since it is associated with an increased risk of deep wound infections and osteomyelitis.

Here we present a case where a novel polylactic acid/gentamicin coated unreamed tibial nail (UTN-PROtect(®)) has been used to successfully salvage the limb of a 17-year-old man, where prolonged external fixation or amputation would have been the standard treatment.

This case demonstrates that treating severe grade IIIc tibial fractures with the acid/gentamicin coated unreamed tibial nail (UTN-PROtect(®)) is a viable alternative to prolonged external fixation or amputation.

The gentamicin-loaded coating of the UTN-PROtect(®) nail, which releases the antimicrobial agent directly at the bone-implant inter-face, overcomes the limitation of insufficient antibiotic delivery. Awareness of this case and the existing literature supporting the use of an antibiotic coated nail may assist surgeons in their decisions on how to treat severe grade IIIc fractures.