The treatment of intramedullary
infections after nailing usually includes removal of the rod,
debridement of the canal, and, in many cases, insertion of
antibiotic-impregnated cement beads. These beads offer no mechanical support and are difficult to remove if left in place for more than 2 weeks. We present an alternative for filling the medullary canal's noncollapsible dead space with an
antibiotic-impregnated cement rod. This rod can be custom-made at the time of surgery, using different diameter
chest tubes as molds and embedding a 3-mm beaded guidewire within the cement. The smooth molded surface of this nail makes extraction of the cement rod relatively easy. The cement rod also provides some limited temporary support to the fracture or nonunion site while the
infection is being treated. After 6 weeks, the rod can be removed and replaced with a definitive
metal intramedullary nail, with or without
bone grafting to treat the previously infected fracture or nonunion site. We retrospectively reviewed nine cases of intramedullary
infection treated with
antibiotic-impregnated molded cement rods. These included six femora, two tibiae, and one humerus. The cause of
infection was lengthening or transport over nail in six cases, fixator-augmented nailing of
osteotomies in two, and
fracture fixation in one. The follow-up period after surgery ranged from 38 to 48 months. No
recurrent infection occurred during this follow-up period, and no patient required
antibiotics after the rod was removed. In all cases, the canal cultures were negative after rod removal. The cement rod was removed between 29 and 753 days after implantation. Fracture of the rod occurred in one case in which the rod was left in place for more than 1 year. We conclude that this method is a relatively simple and inexpensive alternative for the treatment of intramedullary
infections.