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Antibiotic Cement-Coated Nails for the Treatment of Infected Nonunions and Segmental Bone Defects
Raghuram Thonse, MS(Orth), DNB(Orth), FRCS(Glasg), FRCS(Ed)1; Janet D. Conway, MD2
1 Musgrave Park Hospital, Belfast BT9 7JB, United Kingdom. E-mail address: thonser@yahoo.co.uk
2 Rubin Institute for Advanced Orthopedics, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address: jconway@lifebridgehealth.org
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Quantum Medical Concepts). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2008 Nov 01;90(Supplement 4):163-174. doi: 10.2106/JBJS.H.00753
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Treatment of infected nonunions is a challenge faced by many orthopaedic surgeons. Traditionally, the treatment strategy has been control of the infection followed by procedures to achieve osseous union. Débridement, antibiotic-impregnated cement beads, and intravenous antibiotics have been used for the control of the infection1-3. External or internal fixation methods have been used to achieve stability to promote union. Antibiotic cement-coated intramedullary nails can be used to treat the infection with high doses of local antibiotics and to provide bone stability4. Use of these devices allows immediate weight-bearing and prevents many complications associated with external fixation, such as pin-track infections and joint stiffness. This novel approach to the treatment of infected nonunions was developed to minimize the number of additional surgical procedures required for infection control and to achieve bone union. We present our series of fifty-two patients in whom an antibiotic cement-coated intramedullary nail was inserted for the treatment of an infected nonunion or segmental bone defect.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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