Septic femoral shaft non-union treated by one-step surgery using a custom-made intramedullary antibiotic cement-coated carbon nail: case report and focus on surgical technique

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Enrico Bonicoli
Nicola Piolanti
Michele Giuntoli
Simone Polloni
Michelangelo Scaglione


septic non-union, coated nail, infection, one-step surgery, osteomyelitis, femoral fracture, intramedullary nail, carbon nail


Background and aim of the work. In the orthopaedic and traumatological fields septic non-unions represent a severe complication, hard to manage and treat. Traditionally, the surgical technique consist in to two sequential steps: debridement with the delivery of local and systemic antibiotics associated with temporary stabilization of the fracture and subsequent reconstruction of bone and soft tissues. Recently, the use of some devices to treat septic non-union by one-step surgery have been introduced with encouraging results.

Methods: We report our experience in a clinical case treated by one-step procedure using a custom-made intramedullary antibiotic cement-coated carbon nail. We reviewed the literature and described the surgical technique employed in this case.

Results: At 6 months from surgery the patient was able to full weight-bearing and to carry out the normal activities of daily living. Inflammatory blood values normalized and radiographic controls showed the presence of a mechanically good bone callus at non-union site. The bone resection carried out has determined a limb asymmetry in minus of 3 cm that has been corrected through a temporary uplift in the footwear, currently well tolerated. The patient regained the full ROM of right knee.

Conclusion: Intramedullary cemented-coated nail associated with systemic antibiotic therapy has proven to be an effective treatment to control the infection and to provide immediate stability at the septic non-union/fracture site, allowing the patient a rapid functional recovery. It represents a valid option especially in patients who refuse external devices or surgical additional procedures such as in our case.


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