Management of Infected Non-union of Long Bones Using Antibiotic Cement-Coated Intramedullary Nails: A Prospective...

Infected non-union of long bones represents one of the most challenging problems in orthopedic surgery. Conventional two-stage approaches involving debridement, antibiotic spacers, and subsequent fixation are associated with high morbidity and prolonged treatment duration.

We present a prospective case series of 10 patients with infected non-union of various long bones (tibia, femur, humerus) treated with antibiotic cement-coated intramedullary nails (AC-CIMN). The nail was coated with polymethylmethacrylate mixed with culture-sensitive antibiotics in a single-stage procedure combining debridement and mechanical stabilization.

At a mean follow-up of 12 months, infection was successfully controlled in 80% of patients and radiological union was achieved in 70%. Mean union time was 28 weeks for tibial fractures and 22 weeks for femoral fractures. Functional outcomes were satisfactory in 80% of cases. Two patients required secondary intervention for persistent infection.

AC-CIMN is an effective single-stage strategy for infected non-union of long bones with bone gaps ≤2 cm. It simultaneously addresses infection control and mechanical stability, enabling early mobilization. Careful patient selection and culture-guided antibiotic loading are critical determinants of success.