Muhammad Zafar Iqbal Shahid, Sohaib Inaam Ullah, Naveed Ali Shair, Tahir Mehmood, Muhammad Iqbal, Mubashir Farhan.
Antibiotic-Impregnated Cement Coated Ilizarov Rod for Infected Non-Union of Femur.
J Sharif Med Dent Coll Jan ;9(1):22-6.

Objective: To determine the effectiveness of antibiotic-impregnated cement coated Ilizavor rod for infected non-union of the femur. Methodology: It was a prospective observational study conducted at the Department of Orthopedic Surgery Services Hospital, Lahore from December 2018 to December 2020. After approval from the Hospital Ethical Review Board, the study was conducted on 50 patients with infected non-union of the femur or established osteomyelitis of the femur after intramedullary (IM) nailing. Each patient underwent an X-ray of the shaft of the femur with hip and knee joint, both anterior-posterior (AP) & lateral views, complete blood count (CBC) with erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) as baseline investigations. The intramedullary nail was removed and irrigation with resident assessment instrument (RAI) system was done with 7-8 liters of normal saline. An Ilizarov rod of size 5 mm width and length equal to that of IM nail already introduced, was used. It was impregnated with bone cement coated with 2 g of vancomycin and 2 g of gentamicin. Results: A total of 50 patients were enrolled in our study with a mean age of 48.32+/-12.59 years and a range between 40-70 years. Thirty eight (76%) were males and 12(24%) were females. In the initial culture, the Staphylococcus aureus was isolated in 30(60%) patients; Escherichia coli (E. coli) was present in 8(16%) patients, Pseudomonas species in 4(8%) patients, mixed infection in 4(8%), while in 4(8%) patients culture was negative. Vancomycin and gentamicin 2 g each were used with bone cement to impregnate the Ilizarov rods in all the cases. Thirty eight (76%) patients had discharging sinus at the time of presentation. In all these 38 patients, CRP & CBC with ESR returned to normal after 4 to 6 months. Thirty eight out of 50 patients showed signs of union radiologically after 5-6 months. Conclusion: Antibiotic-impregnated cement rods are very effective in the treatment of infected non-union of the femur. It is a unique implant to control the infected non-union and provides stability for fracture union. Keywords: Femoral fractures. Bone cement. Intramedullary nailing. Antibiotics.

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