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. 2021 Apr 17;16(1):270.
doi: 10.1186/s13018-021-02411-8.

Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail-clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating

Nike Walter  1   2 , Daniel Popp  1 , Viola Freigang  1 , Michael Nerlich  1 , Volker Alt  1 , Markus Rupp  3
Affiliations

Treatment of severely open tibial fractures, non-unions, and fracture-related infections with a gentamicin-coated tibial nail-clinical outcomes including quality of life analysis and psychological ICD-10-based symptom rating

Nike Walter et al. J Orthop Surg Res. .

Abstract

Background: Implant-associated infections depict a major challenge in orthopedics and trauma surgery putting a high burden on the patients and health care systems, strongly requiring improvement of infection prevention and of clinical outcomes. One strategy includes the usage of antimicrobial-coated implants. We evaluated outcomes after surgical treatment using a gentamicin-coated nail on (i) treatment success in terms of bone consolidation, (ii) absence of infection, and (iii) patient-reported quality of life in a patient cohort with high risk of infection/reinfection and treatment failure.

Methods: Thirteen patients with open tibia fractures (n = 4), non-unions (n = 2), and fracture-related infection (n = 7) treated with a gentamicin-coated intramedullary nail (ETN ProtectTM) were retrospectively reviewed. Quality of life was evaluated with the EQ-5D, SF-36, and with an ICD-10-based symptom rating (ISR).

Results: At a mean follow-up of 2.8 years, 11 of the 13 patients (84.6%) achieved bone consolidation without any additional surgical intervention, whereas two patients required a revision surgery due to infection and removal of the implant. No specific implant-related side effects were noted. Quality of life scores were significantly lower compared to a German age-matched reference population. The mean ISR scores revealed mild psychological symptom burden on the scale depression.

Conclusion: The use of a gentamicin-coated intramedullary nail seems to be reasonable in open fractures and revision surgery for aseptic non-union or established fracture-related infection to avoid infection complications and to achieve bony union. Despite successful treatment of challenging cases with the gentamicin-treated implant, significantly reduced quality of life after treatment underlines the need of further efforts to improve surgical treatment strategies and psychological support.

Keywords: Antimicrobial-coated nails; Infection prevention; Quality of life.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mean physical health component score (PCS) and mean mental health component score (MCS) of successfully treated patients assessed with the SF-36.* Significant difference
Fig. 2
Fig. 2
Subdimension scores for patient-related quality of life assessed with the SF-36.* Significant difference
Fig. 3
Fig. 3
Results of the EQ-5D subdimensions given in percentage
Fig. 4
Fig. 4
Mean values of the ISR scores obtained from successfully treated patients. The dotted line illustrates the border to considered mild psychological symptom burden
See this image and copyright information in PMC

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