Coated nails: is their use supported by the literature?

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering
• Infectious Disease Management

Background:

• Long-bone infections, particularly diaphyseal ones involving fractures and nonunions, pose significant treatment challenges.
• Antibiotic-coated intramedullary nails have emerged as a key therapeutic strategy in recent decades.
• These devices combine mechanical stability with localized antibiotic delivery.

Purpose of the Study:

• To review the application and effectiveness of antibiotic-coated intramedullary nails for treating long-bone infections.
• To highlight the manufacturing process and customization techniques.
• To summarize reported outcomes and identify areas for future research.

Main Methods:

• Nails are constructed by injecting antibiotic-impregnated polymethylmethacrylate (cement) around a metal core using a silicone mold.
• Various techniques allow for customization to the specific anatomical site.
• Antibiotic cement serves as a proven local antibiotic delivery system.

Main Results:

• Antibiotic cement effectively elutes high antibiotic concentrations with low systemic toxicity.
• Case series report favorable outcomes, including successful bone union and infection eradication.
• The technique provides essential stability for diaphyseal infections.

Conclusions:

• Antibiotic-coated intramedullary nails are a valuable option for managing complex long-bone infections.
• The localized delivery system ensures high antibiotic concentrations at the infection site.
• Further investigation is required to establish optimal weight-bearing capacity and antibiotic elution profiles.