Novel Antibacterial coatings of Intramedullary Nails use in high risk Tibial fractures: do they make a difference?
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All Authors
Kanakaris, Nikolaos
Strain, Ritchie
Giannoudis, Peter V.
LTHT Author
Kanakaris, Nikolaos
Strain, Ritchie
Giannoudis, Peter V
Strain, Ritchie
Giannoudis, Peter V
LTHT Department
Trauma & Related Services
Orthopaedics
Orthopaedics
Non Medic
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Background:
Fracture-related-infections (FRI) represent a complex problem which has grave socio-economic impact to the patient and to the health system. One of the recently emerging prevention strategies of FRI has been the use of antibacterial-coated implants.
Aims:
To evaluate for the first time, the clinical effectiveness of the 2 commercially available in the UK, coated tibial nails (PROtect of Depuy-Synthes and Bactiguard of Zimmer-Biomet) in comparison to standard non-coated nails for stabilisation of high risk for FRI tibial fractures.
Methods:
Prospective collection of relevant data of patients with minimum follow-up of 12months. High-risk was defined as open injuries, post-fasciotomies, post an external fixator. Statistical analysis was performed using Stata, with a significance level of p < 0.05.
Results
A cohort of 234 high-risk tibial fractures treated at Leeds Major Trauma Centre (102 PROtect nail group, 41 Bactiguard nail group & 91 non-coated nail group). There were no statistically significant differences in the epidemiological and comorbidity characteristics, the severity of associated injuries, the fracture types, the severity of soft tissue trauma, or the time to definitive fixation or soft tissue management between the coated nail groups. Overall, the incidence of FRI was 9.4% (22/234 cases). For the PROtect 7.8% (8/102), for the Bactiguard 4.9% (2/41) and 13.2% (12/91) for the non-coated nails (p=0.167). Staphylococcus was the most common species isolated (in 65% of all positive samples) whereas there were 11 (29.7%) polymicrobial and 10.8% multi-resistant species. Uncomplicated fracture-union was recorded in 64.7%vs.65.9%vs.53.8% respectively, and un-planned secondary interventions and readmissions were required in 26.5%vs.22%vs.41.8% respectively (p=0.009).
Conclusions
In high-risk patients both types of coated nails achieved lower incidence of FRI and less readmissions compared with non-coated intramedullary implants. The precise impact of antibacterial-coatings of tibial nails on the prevention of FRI should be investigated in a randomised multicentre trial.