Septic Tibial Shaft Non-Union Treated by One-Step Surgery Using a Custom-Made Intramedullary Antibiotic Cement-Coated Carbon Nail: Case Report, Focus on Surgical Technique and Brief Literature Review

Septic non-union (SNU) represents an insidious complication of open fractures. SNU is defined as a clinical and radiological evidence of cessation of fracture healing after 6-8 months of treatment, associated with persistence of clinical, laboratoristic and radiological signs of infection. The infection is mostly caused by bacteria and when it occurs at the bone fracture site, the healing process slows down and generally the treatment takes place in multiple phases. First a surgical debridement, often with the use of polymethylmethacrylate and local antibiotics, associated with specific systemic antibiotic therapy and a temporary stabilization of the septic non-union. Once the infection is cleared up, the final definitive synthesis is performed. Recently the use of implantable antibiotic medical devices in one step surgery has been introduced with encouraging results and have shown numerous advantages both in terms of management and morbidity for the patient. There are several "pre-formed" devices on the market, which however must be approved by the institution and often have the limit of a high cost in addition to the impossibility of using specific antibiotics. We want to report our experience with a clinical case of a tibial SNU successfully treated by one-step surgery procedure using a custom-made intramedullary antibiotic cement-coated carbon nail. We focus on surgical technique, advantages and pitfalls related to the use of these devices.