Removal of Antibiotic Cement-Coated Interlocking Nails

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Infectious disease management

Background:

• Antibiotic cement-coated interlocking nails (ACCINs) are utilized for fracture fixation and infection prophylaxis.
• Challenges exist in the removal of ACCINs, particularly concerning the integrity of the antibiotic coating.
• Developing effective removal techniques is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the outcomes of ACCIN removal.
• To present a technique minimizing antibiotic coating debonding during removal.
• To describe intraoperative management strategies for ACCIN removal complications.

Main Methods:

• Retrospective case series of 28 patients undergoing ACCIN removal.
• Utilized the silicone tubing method for antibiotic cement coating.
• Documented removal success rates, debonding incidence, and need for additional procedures.

Main Results:

• Successful ACCIN removal achieved in 88.1% (37/42) of cases.
• Antibiotic coating debonding occurred in 11.9% (5/42) of removals.
• Additional removal procedures were required in 19% for nonunion and 7.1% for persistent infection.

Conclusions:

• ACCIN insertion and removal present technical challenges.
• Proper coating and insertion techniques can simplify ACCIN removal.
• Removal of knee-long fusion rods may be more complex.