Talal B Abalkhail1,2, Ahmed H Elhessy1, Janet D Conway1. 1. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; and. 2. Department of Orthopedics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Abstract
OBJECTIVES: To report the outcomes of antibiotic cement-coated interlocking nail (ACCIN) removal, detail a removal technique that mitigates debonding of coating, and describe how to address occurrences intraoperatively. DESIGN: Retrospective case series. SETTING: Level II trauma center. PATIENTS: Twenty-eight patients who underwent ACCIN removal between January 2014 and August 2019. INTERVENTION: Removal of ACCINs that were coated using the silicone tubing method. MAIN OUTCOME MEASUREMENTS: Successful removal of the nail with intact antibiotic coating. RESULTS: A total of 42 ACCIN removals were included in this study. Successful ACCIN removal was achieved in 37 cases (88.1%), with debonding in only 5 cases (11.9%). Eight nails (19%) required 1 additional removal procedure, and 3 nails (7.1%) required 2 additional removal procedures. The main reasons for the additional procedures were nonunion and persistent infection. CONCLUSIONS: ACCIN insertion and removal can be challenging. The proper technique of coating and insertion can facilitate later removal. Removal of knee-long fusion rods can be more challenging. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To report the outcomes of antibiotic cement-coated interlocking nail (ACCIN) removal, detail a removal technique that mitigates debonding of coating, and describe how to address occurrences intraoperatively. DESIGN: Retrospective case series. SETTING: Level II trauma center. PATIENTS: Twenty-eight patients who underwent ACCIN removal between January 2014 and August 2019. INTERVENTION: Removal of ACCINs that were coated using the silicone tubing method. MAIN OUTCOME MEASUREMENTS: Successful removal of the nail with intact antibiotic coating. RESULTS: A total of 42 ACCIN removals were included in this study. Successful ACCIN removal was achieved in 37 cases (88.1%), with debonding in only 5 cases (11.9%). Eight nails (19%) required 1 additional removal procedure, and 3 nails (7.1%) required 2 additional removal procedures. The main reasons for the additional procedures were nonunion and persistent infection. CONCLUSIONS: ACCIN insertion and removal can be challenging. The proper technique of coating and insertion can facilitate later removal. Removal of knee-long fusion rods can be more challenging. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.