The coating of medical devices with
antimicrobial agents has recently emerged as a potentially effective method for the prevention of device-related
infections. We examined the anti-infective efficacy of intramedullary nails coated with an
antiseptic combination of
chlorhexidine and
chloroxylenol in a rabbit model of device-related
infection after fixation of an open
tibial fracture. The rabbits were randomized to receive 2.8-by-100-millimeter
stainless-steel tibial intramedullary nails that either were uncoated or were coated with
antiseptic. After administration of
anesthesia and preoperative
antibiotic prophylaxis, a
tibial fracture was created and then reduced with insertion of the intramedullary nail. A bacterial inoculum of 10(6) colony-forming units of Staphylococcus aureus was injected into the intramedullary canal, and the
wound was sutured. Radiographs of the tibiae were made postoperatively, and the rabbits were monitored daily. They were killed at six weeks, or earlier if there was dehiscence of the
wound, the fracture became grossly unstable, or the rabbit failed to thrive. The use of the
antiseptic-coated nails was associated with a significantly lower rate of device-related
osteomyelitis (two of twenty-two; 9 per cent) than the use of the uncoated nails (thirteen of twenty-one; 62 per cent) (p = 0.0003). The radiographic and histopathological findings were generally similar in the two groups of rabbits.
Antiseptic agents were not detected in serum. The results suggest that
antiseptic-coated
fracture-fixation devices provide significant local protection against Staphylococcus aureus, which is the most common cause of
infections related to orthopaedic devices.