Intramedullary nailing with an absorbable antibiotic bone graft substitute in fracture-related infections and...

Fracture-related infections (FRI), infected nonunions, and osteomyelitis with bony instability require aggressive treatment involving systemic antibiotics and surgical debridement. Adjuvant local antibiotic therapy delivers higher and sustained concentrations directly to the site of infection while minimizing systemic toxicity. Antibiotic-loaded poly-methyl methacrylate remains a standard option but presents significant limitations, including nonbiodegradability, reduced antibiotic elution over time, and the need for subsequent removal. Cerament G is a bioabsorbable bone void filler composed of calcium sulfate, hydroxyapatite, and gentamicin sulfate. It provides sustained high-dose antibiotic release, promotes osteoconduction, and remodels into bone within 6 to 12 months, eliminating the need for removal. This makes Cerament G a compelling option for the treatment of FRI and osteomyelitis.

We describe a technique and case series using the Reamer-Irrigator-Aspirator (RIA) system, Cerament G injection via the 2Can device, and, when necessary, intramedullary nailing for the treatment of FRI and osteomyelitis. The technique was applied to 7 patients at a single Level-1 Trauma Center from 2022 to 2024 with FRI or osteomyelitis. Intramedullary nailing was performed in cases of nonunion or bony instability.

The mean age of patients was 35 years, with a mean body mass index of 29.2. Three patients required adjuvant intramedullary nailing for stabilization. All patients were weight bearing as tolerated after surgery. At a mean follow-up of 14.4 months (6-21 months), there were no recurrence of infection, major complications, or amputations.

The combination of Cerament G and the RIA system represents a viable solution for FRI and osteomyelitis providing effective infection control and sustained antibiotic elution. This technique presents a promising alternative to traditional methods, although larger and longer-term studies are needed to confirm its efficacy.