Implant related
sepsis is a relatively unusual complication of intra-medullary nail fixation of long
bone fractures. Depending on the extent of
infection, timing of diagnosis and progress of fracture union, different treatment strategies have been developed. The aim of this review article is to collect and analyze the existing evidence about the incidence and management of
infection following IM nailing of long
bone fractures and to recommend treatment algorithms that could be valuable in everyday clinical practice. After searching the P u b M e d /Medline databases, 1270 articles were found related to the topic during the last 20 years. The final review included 28 articles that fulfilled the inclusion criteria. Only a few prospective studies exist to report on the management of
infection following IM nailing of long-
bone fractures. In general, stage I (early)
infections only require
antibiotic administration with/without
debridement. Stage II (delayed)
infections can be successfully treated with
debridement, IM reaming,
antibiotic nails, and administration of
antibiotics. Infected non-unions are best treated with exchange nailing,
antibiotic administration and when
infection has been eradicated with graft implantation if it is needed.
Debridement, exchange nailing and systemic administration of
antibiotics is the best indication for stage III (late)
infections, while stage III infected non-unions can successfully be treated with nail removal and Ilizarov frame, especially when large bone defects exist.