Diagnosis and management of infection after tibial intramedullary nailing

A series of 20 patients with infection after intramedullary nailing of the tibia is discussed. The most common pathogen was Staphylococcus aureus, which was found in 14 patients (64%). Eleven nails were originally inserted without reaming, and 9 were reamed. Treatment protocols were based on the time of onset of infection (acute, subacute, and chronic) and the status of bone healing. In eight patients, the fractures (6) and nonunions (2) were healed at diagnosis of infection and were treated by debridement, nail removal, and antibiotics. Twelve patients had fractures (8) and nonunions (4) that were not healed. Four were treated with debridement, nail removal, and external fixation, and four with debridement and nail retention. The overall success rate for eradicating infection was 90%. Infection after unreamed nailing had fewer complications and a higher success rate for infection control than did reamed nailing. Risk factors identified in this study for infection are previous external fixation, severe open fracture, and substance abuse.