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

URN to cite this document:

urn:nbn:de:bvb:355-epub-517701 Copy

DOI to cite this document:

10.5283/epub.51770 Copy

Walter, Nike ; Popp, Daniel ; Freigang, Viola ; Nerlich, Michael ; Alt, Volker ; Rupp, Markus

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License: Creative Commons Attribution 4.0 PDF - Published Version (756kB)

Date of publication of this fulltext: 21 Feb 2022 09:42

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Details

Item type:	Article
Journal or Publication Title:	Journal of Orthopaedic Surgery and Research
Publisher:	BMC Open
Volume:	16
Number of Issue or Book Chapter:	1
Page Range:	pp. 1-8
Date:	17 April 2021
Institutions:	Medicine > Lehrstuhl für Unfallchirurgie
Projects:	Projekt DEAL
Identification Number:	Value Type 10.1186/s13018-021-02411-8 DOI
Keywords:	Antimicrobial-coated nails, Infection prevention, Quality of life
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	51770

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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) ...

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.

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Metadata last modified: 21 Feb 2022 15:12

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