Abstract
Introduction
Severe grade IIIc tibial fractures have limited treatment options. The decision between limb salvage or amputation depends on many factors, including the age and health status of the patient, as well as the soft tissue status and associated injuries. Until recently, intramedullary nailing was not a favoured treatment option in such tibial fractures, since it is associated with an increased risk of deep wound infections and osteomyelitis.
Material and methods
Here we present a case where a novel polylactic acid/gentamicin coated unreamed tibial nail (UTN-PROtect®) has been used to successfully salvage the limb of a 17-year-old man, where prolonged external fixation or amputation would have been the standard treatment.
Results
This case demonstrates that treating severe grade IIIc tibial fractures with the acid/gentamicin coated unreamed tibial nail (UTN-PROtect®) is a viable alternative to prolonged external fixation or amputation.
Conclusion
The gentamicin-loaded coating of the UTN-PROtect® nail, which releases the antimicrobial agent directly at the bone–implant inter-face, overcomes the limitation of insufficient antibiotic delivery. Awareness of this case and the existing literature supporting the use of an antibiotic coated nail may assist surgeons in their decisions on how to treat severe grade IIIc fractures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gaebler C, Berger U, Schandelmaier P, Greitbauer M, Schauwecker HH, Applegate B, et al. Rates and odds ratios for complications in closed and open tibial fractures treated with unreamed, small diameter tibial nails: a multicenter analysis of 467 cases. J Orthop Trauma. 2001;15:415–23.
Tsukayama DT (1999) Pathophysiology of posttraumatic osteomyelitis. Clin Orthop Relat Res. 22–29.
Young EJ, Sugarman B. Infections in prosthetic devices. Surg Clin North Am. 1988;68:167–80.
Petrisor B, Anderson S, Court-Brown CM. Infection after reamed intramedullary nailing of the tibia: a case series review. J OrthopTrauma. 2005;19:437–41.
Raschke MJ, Mann JW, Oedekoven G, Claudi BF (1992) Segmental transport after unreamed intramedullary nailing. Preliminary report of a “Monorail” system. Clin Orthop Relat Res. 233–240.
Schmidmaier G, Lucke M, Wildemann B, Haas NP, Raschke M. Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review. Injury. 2006;37(Suppl 2):S105–12.
Diefenbeck M, Muckley T, Hofmann GO. Prophylaxis and treatment of implant-related infections by local application of antibiotics. Injury. 2006;37(Suppl 2):S95–104.
Hertel R, Strebel N, Ganz R. Amputation versus reconstruction in traumatic defects of the leg: outcome and costs. J Orthop Trauma. 1996;10:223–9.
Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. J Orthop Trauma. 2007;21:70–6.
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–31.
Giannoudis PV, Harwood PJ, Kontakis G, Allami M, Macdonald D, Kay SP, et al. Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation). Injury. 2009;40:213–9.
Fairhurst MJ (1994) The function of below-knee amputee versus the patient with salvaged grade III tibial fracture. Clin Orthop Relat Res. 227–232.
Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg. 1999;103:1212–20.
Dahl B, Andersson AP, Andersen M, Andersen GR, Ebskov LB, Reumert T. Functional and social long-term results after free tissue transfer to the lower extremity. Ann Plast Surg. 1995;34:372–5.
Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL. Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am. 1993;75:1431–41.
Korompilias AV, Beris AE, Lykissas MG, Vekris MD, Kontogeorgakos VA, Soucacos PN. The mangled extremity and attempt for limb salvage. J Orthop Surg Res. 2009;4:4.
Helgeson MD, Potter BK, Tucker CJ, Frisch HM, Shawen SB. Antibiotic-impregnated calcium sulfate use in combat-related open fractures. Orthopedics. 2009;32:323.
Wahlig H. Gentamicin-PMMA beads: a drug delivery system in the treatment of chronic bone and soft tissue infections. J Antimicrob Chemother. 1982;10:463–5.
Conflict of interest statement
M. Raschke holds parts of the patent for antibiotic coating, which was licend to Synthes® (Oberdorf, Switzerland).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Raschke, M., Vordemvenne, T. & Fuchs, T. Limb salvage or amputation? The use of a gentamicin coated nail in a severe, grade IIIc tibia fracture. Eur J Trauma Emerg Surg 36, 605–608 (2010). https://doi.org/10.1007/s00068-010-0017-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-010-0017-x