Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis.

PURPOSE: Tibial open shaft fractures are very common and susceptible to infection, which can lead to significant morbidity especially infection and non-union. Antibiotic coated nail is one option for fixing open shaft tibial fractures to minimise infection. This study aimed to compare the clinical outcome of Gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails in the treatment of type I and II tibial open fractures.

METHODS

Between 2013 and 2020, in a retrospective study of 124 patients with Gustilo type I and II tibial fractures compared non-antibiotic-coated nails (62 patients) with gentamicin-coated nails (62 patients) over 12 months. This study assessed infection rates, duration of hospital stays, fracture union time, and complications.

RESULTS

The antibiotic nail group had significantly lower postoperative infection rates (3.2%) than the regular nail group (17.7%), (χ2 = 4.64, p = 0.031). At the 6-month follow-up, significant differences were observed in ESR (p = 0.031), CRP (p = 0.019), leukocyte count (p = 0.0241), and blood culture (p = 0.018), but not in hemoglobin levels (p = 0.067). The Gentamicin-coated nail group demonstrated better fracture union rates at 6 and 12 months, (p = 0.0267) and lower overall complication rates.

CONCLUSION

A tibial nail coated with Gentamicin is an effective method for preventing infection in type I and II open fracture shafts of the tibia. It allows, shortens hospital stay and healing time, prevents infection, and thus reduces the chance of a second surgery.

LEVEL OF EVIDENCE: Level III, a retrospective study.

DESIGN

Retrospective analytical study.

HYPOTHESIS: We hypothesized that Gentamicin-coated nail is effective in preventing infection in Gustilo type I and II open fractures compared to non-antibiotic-coated regular nails.