title: The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature.
abstract: BACKGROUND
  Despite modern advances in fracture care, deep (implant-related) infection remains a problem in the treatment of tibia fractures. There is some evidence that antibiotic-coated implants are beneficial in the prevention of this sometimes devastating complication. In the following study we describe our results using a gentamicin-coated intramedullary tibia nail (Expert Tibia Nail (ETN) PROtect™) for the surgical treatment of complex open tibia fracture and revision cases.
  
  
  METHODS
  We describe the outcome of patients treated between January 2012 and September 2013, using a gentamicin-coated intramedullary tibia nail. Treatment indications included acute, Gustilo grade II-III, open tibia fractures or closed tibia fractures with long-term external fixation prior to intramedullary nailing and complex tibia fracture revision cases with a mean of three prior surgical interventions. Outcome parameters in this study were deep infection and nonunion.
  
  
  RESULTS
  In total, 16 consecutive patients with 16 tibia fractures were treated with a gentamicin-coated intramedullary nail. The overall patient population was subdivided into two groups. The first group consisted of 11 patients (68.8%) with acute fractures who were treated with a gentamicin-coated intramedullary nail. The second group consisted of 5 complex revision cases (31.2%). In our patient population no deep infections could be noted after the treatment with a gentamicin-coated tibia nail. Nonunion was diagnosed in 4 patients (25.0%), 1 of these was a revision case.
  
  
  CONCLUSIONS
  Musculoskeletal complications place a cost burden on total healthcare expenditure. Better understanding of the epidemiology and pathogenesis is essential because this can lead to prevention rather than treatment strategies. The purpose of the study was to evaluate a gentamicin-coated tibia nail in the prevention of deep (implant-related) infection. In our patient population no deep infections occurred after placement of the gentamicin-coated nail. Following this study and literature data, antibiotic-coated implants seem a potential option for prevention of deep infection in trauma patients. In the future this statement needs to be confirmed by large randomised clinical trials.
authors.affiliation: University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium. Electronic address: wilhelmus.metsemakers@uzleuven.be.
authors.forename: W J
authors.initials: WJ
authors.lastname: Metsemakers
authors.affiliation: University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Reul
authors.affiliation: KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Nijs
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001530:Belgium / Q000453:epidemiology; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013978:Tibial Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Coating; Complications; Gentamicin; Implant related-infection; Intramedullary nailing; Nonunion; Tibia fracture