Prophylactic use of antibiotic coated intramedullary nail in open tibia fractures

Abstract

Background and Aim: Open fracture of tibia is one of the most common injuries seen in ortho pedic practice. The appropriate treatment of open tibial fractures is one of the priority problems in modern era of traumatology. Present study was done with an aim to assess functional and clinical outcome after intramedullary locking nail fixation of open fracture shaft of tibia. Material and Methods: This prospective study was conducted in the Department of Orthopaedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. 40 patients were treated over a period of 16 months with gentamicin coated tibia interlocking nail after taking written and informed consent. Antibiotic coated tibia interlocking nail with property of sustained release of gentamicin was used. The coating contains combination of gentamicin and biodegradable polymeric carrier Poly. An average size nail carries 100 mg (1 mg/cm2) gentamicin drug. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Results: The most common cause of injury was found to be due to road traffic accident. Fibula fracture was associated with 92.5% of patients. Time taken in wound healing in majority of patients was less than 5 weeks (45%). Majority of patents (47.5%) had RUST score 8 at six months of duration. Two cases got infected in this study and in one case there was non-union. Average duration of hospital stay was 15 days. Large numbers of patients had fair outcome 45%. Conclusion: In this study we showed that use of antibiotic coated nail to treat open tibial fracture was associated with an absence of deep wound infections. Antibiotic coated tibia interlocking nail is a good treatment option for open tibial fractures, yields good functional outcome with less complications in these fractures and should be used whenever indicated.