An evaluation of the results of medullary nailing in the treatment of infected diaphysial fractures

Abstract

Twenty infected diaphysial fractures were treated by debridement and intramedullary nailing under antibiotic cover after a period of initial wound care; 12 were over 1 mth old at the time of operation; 14 had severe infection and 6 showed low grade infection; 19 were followed for a minimum period of 5 mth and a maximum of 3 yr (average 19.1 mth); one was lost to follow up after 2 mth when the infection was well healed; soft tissue healing was finally achieved in 18. Prolonged minimal drainage was seen in 14; in 12 of these the infection subsided after implant removal and sinus curettage; minor sequestrectomy was performed in 4 following fracture union. Fourteen fractures healed within 6 to 10 mth (average 6.7 mth); 3 required secondary bone grafting for delayed union; 15 had excellent good results, while 2 were classified as satisfactory; 2 are showing good progress and awaiting full consolidation. The main advantages of this treatment include a rapid improvement in patient's general condition with relief of pain, control of infection with gradual healing of the wound, early restoration of weight bearing capacity, and eventual union of the fracture. Properly applied with caution under optimum operating conditions, intramedullary nailing is an effective salvage procedure for infected fractures with soft tissue or bone loss.