Removal of Antibiotic Cement-Coated Interlocking Nails
Related Experiment Video
Updated: Oct 16, 2025
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Talal B Abalkhail1,2, Ahmed H Elhessy1, Janet D Conway1
1International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; and.
Objectives:
To report the outcomes of antibiotic cement-coated interlocking nail (ACCIN) removal, detail a removal technique that mitigates debonding of coating, and describe how to address occurrences intraoperatively.
Design:
Retrospective case series.
Setting:
Level II trauma center.
Patients:
Twenty-eight patients who underwent ACCIN removal between January 2014 and August 2019.
Intervention:
Removal of ACCINs that were coated using the silicone tubing method.
Main Outcome Measurements:
Successful removal of the nail with intact antibiotic coating.
Results:
A total of 42 ACCIN removals were included in this study. Successful ACCIN removal was achieved in 37 cases (88.1%), with debonding in only 5 cases (11.9%). Eight nails (19%) required 1 additional removal procedure, and 3 nails (7.1%) required 2 additional removal procedures. The main reasons for the additional procedures were nonunion and persistent infection.
Conclusions:
ACCIN insertion and removal can be challenging. The proper technique of coating and insertion can facilitate later removal. Removal of knee-long fusion rods can be more challenging.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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