• Harpal Singh Selhi, Pankaj Mahindra, Mohd Yamin, Deepak Jain, William G De Long, and Jaspreet Singh.
• Department of Orthopedic Surgery, Dayanand Medical College & Hospital, Ludhiana, Punjab (India). drharpal@gmail.com
• J Orthop Trauma. 2012 Mar 1; 26 (3): 184-8.

ObjectivesThis study looks at the treatment of 16 cases of infection in long bone fractures that had an adverse effect on healing. The goal was to find a method that may be effective in getting these most difficult injuries to heal. The use of reinforced antibiotic-impregnated bone cement rods was studied to see if this could be an effective form of treatment. The use of such devices makes sense because they provide stability that the fractures need for healing while also providing a high concentration of antibiotics locally. The concept was to reduce the amount of metal used for stability while still giving the fracture the correct milieu for healing.DesignThis was a retrospective analysis of 16 patients with infected nonunions of long bones. A protocol for the use of intravenous and per oral antibiotics was developed based on the type of bacteria found from cultures of the infected sites. All cases included operative débridement and stabilization with a reinforced antibiotic-impregnated bone cement rod.PatientsThe patient population was selected from all those who presented to the Department of Orthopaedic Surgery of Dayanand Medical College & Hospital, Ludhiana, India.Main OutcomeSuccess was considered when the nonunion healed and the limb became functional.ResultsThe infected nonunions were treated successfully in 14 of 16 cases. This represents an alternative to external fixation alone as a means of stabilizing nonunions while providing a high concentration of antibiotic locally for combating this most difficult problem.ConclusionsThe use of reinforced antibiotic-impregnated bone cement rods with appropriate surgical débridement and antibiotics may be an effective way of treating infected nonunions of long bones.Level Of EvidenceTherapeutic Level IV. See page 128 for a complete description of levels of evidence.

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