Antibiotic-coated nails in orthopedic and trauma surgery: state of the art.

Optimal management of deep infections in orthopedic and trauma surgery is often challenging. Traditional prophylactic and treatment approaches are based on the systemic administration of relatively high doses of antibiotics, which may result in a number of side effects. Furthermore, systemically administered antimicrobials may not reach adequate concentration at the desired site. Finally, traditional approaches are based on two-step protocols, thus delaying definite fixation. In recent years, antibiotic-coated intramedullary nails (ACINs) have been introduced, which offer the advantage of delivering antibiotics locally, thus increasing their local concentrations and length of action. In addition, ACINs offer the great advantage of combining antimicrobial prophylaxis/treatment and stabilization in a single step. Preliminary evidence by small clinical studies appears to support the effectiveness of ACINs in the management of chronic osteomyelitis and infected non-unions, with high rates of infection eradication and bone union. However, randomized clinical trials are needed to definitely establish ACINs ' effectiveness and safety.