Nailing treatment in bone transport complications

A series of cases of intramedullary nailing with reaming, carried out after complications in regenerated bone and docking site had occurred, is presented here. Nine patients (involving 5 femurs, and 4 tibias) had previously been treated with resection and bone transport after open fractures with loss of bony tissue and infection. Before bone transport, there was Staphylococcus aureus infection in 6 cases and Pseudomonas Aeruginosa in 3. The mean length of regenerated bone was 9.5 cm (min. 6, max. 18). After transport, the fixator remained in place for a mean period of 12.8 months (min. 8, max. 24). In 6 cases (4 femurs, 2 tibias), the thickness of the cortical wall was insufficient and, in 2 of these, there was nonunion of the docking site. In 2 tibias, nailing was carried out shortly after the fixator had been removed, after refracture of the regenerated bone due to insufficient cortical thickness. In one femur, nailing was carried out because of nonunion with the docking site. Follow-up involved clinical and X-ray checks. The mean follow-up was 3.9 years (min. 2, max. 6). In all cases, union and corticalization was complete on average 6 months after nailing (min. 4, max. 11). Infection appeared in only one tibia 4 months after nailing and complete corticalization. The infection was treated with antibiotics and the nail subsequently removed. We conclude that nailing is an excellent solution for regenerated bone and docking site problems, as long as antibiotic therapy is prescribed for at least 10 days after the fixator has been removed. Complications due to infections after nailing are not frequent and can be resolved relatively easily.