Custom-made antibiotic cement nails: a comparative study of different fabrication techniques.
BACKGROUND
The management of intramedullary long bone infections remains a challenge. Placement of antibiotic cement nails is a useful adjuvant to the antibiotic treatment of osteomyelitis. However, fabrication of antibiotic cement nails can be arduous. The purpose of this article is to introduce an easy and reproducible technique for the fabrication of antibiotics cement nails.


METHODS
We compared the time required to peel the chest tube off the 6 antibiotic cement nail using 2 different cement-cooling techniques and the addition of mineral oil in the chest tube. Additionally, we evaluated the optimal time to cut the chest tube (before and after cement hardening), consistency of nail's diameter, and the roughness of its surface. Cooling and peeling times were measured and failure was defined as a working time (from cement mixing to have a usable antibiotic cement nail) that exceeded 1 h.


RESULTS
When the antibiotic cement nail was left to cool by convection (i.e. air-cooling), we failed to peel the plastic off the cement nail. When the chest tube was cut after conductive cooling (i.e. cold water-cooled), the cooling time was 10 min and the peeling time was 30 min without the use of mineral oil; the addition of mineral oil reduced peeling time to 7.5 min. Following peeling, residual adherent plastic pieces were found along the entire surface of the nail when no mineral oil was used. This was rarely seen when mineral oil was utilized to coat the inner layer of the chest tube.


CONCLUSIONS
Conductively cooling of the cement nail (in cold water) and pre-lubricating the chest tube with mineral oil are 2 tricks that render fabrication of antibiotic nail more efficient, reliable, and practical.
Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan 612-862, Republic of Korea.
Ji Wan
JW
Kim
Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Derly O
DO
Cuellar
Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Jiandong
J
Hao
Department of Orthopaedics, University Hospital Louisville, 530 South Jackson Street, Third floor, Louisville, KY 40202, USA.
David
D
Seligson
Department of Orthopaedics, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA. Electronic address: Cyril.mauffrey@dhha.org.
Cyril
C
Mauffrey
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001843:Bone Cements / Q000494:pharmacology*; D001858:Bone Nails; D015505:Chest Tubes; D020099:Coated Materials, Biocompatible / Q000494:pharmacology; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D008422:Materials Testing; D008899:Mineral Oil / Q000494:pharmacology; D010019:Osteomyelitis / Q000517:prevention & control / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D008899:Mineral Oil
Antibiotic cement nails; Intramedullary infection; Osteomyelitis