Management of Infected Intramedullary Nails

Abstract

The presence of foreign bodies lowers the threshold of bacterial infection and generates local immunosuppression. All implants undergo physiological changes after implantation. The earliest and probably clinically the most important step is the "race for the surface," a contest between tissue cell integration and bacterial adhesion to that same surface. The pathogenesis of infections associated with fracturefixation devices is related to microorganisms growing in biofilms, which render these infections difficult to treat. The nature of biofilm structure and the physiological attributes of biofilm organisms confer an inherent resistance to antimicrobial agents, whether these antimicrobial agents are antibiotics, disinfectants, or germicides. Most infections are caused by staphylococci and are acquired during trauma or subsequent fracture-fixation procedures.