Chronic osteomyelitis after cephalomedullary nailing for intertrochanteric fractures of the femur: carbon fiber rod bone cement combined with calcium sulfate loaded with antibiotics.

BACKGROUND: Infection after intramedullary nail fixation for intertrochanteric fractures is relatively rare. In this study, we investigated and compared the therapeutic effects of combined treatment with antibiotic bone cement carbon fiber rods loaded with antibiotic calcium sulfate and the traditional Masquelet technique on chronic osteomyelitis after intramedullary nail fixation for intertrochanteric fractures. METHODS: A retrospective analysis was conducted on 88 patients with chronic osteomyelitis after intramedullary nail internal fixation for intertrochanteric fractures in our hospital from September 2018 to September 2024. The patients were divided into two groups (n = 44 patients/group) based on the different surgical plans implemented to treat these patients. The control group was treated using the Masquelet technique. After debridement, the first stage involved treatment with antibiotic bone cement rods, and the second stage involved bone grafting. The experimental group was treated with the antibiotic calcium sulfate in the second stage, based on the first stage of the control group. The inflammatory indicators, therapeutic effects, and pain conditions of the patients six weeks after the operation were recorded. Corresponding evaluations were conducted for the two groups to comprehensively assess and compare the therapeutic effects of the two surgical methods. RESULTS: The wound healing time and bone healing time of the patients in the experimental group were shorter than those in the control group, and the total effective rate was significantly greater than that in the control group (P < 0.05). No significant difference was found in the operation time between the two groups (P > 0.05). The levels of postoperative inflammatory indicators in both groups were significantly lower than those before treatment, and the levels in the experimental group were significantly lower than those in the control group (P < 0.05). The pain scores of the two groups of patients decreased at two weeks, one month after treatment, and three months after follow-up. Moreover, the pain scores of the experimental group were lower than those of the control group, and the difference was significant (P < 0.05). CONCLUSION: The combined treatment of postoperative infection with antibiotic-containing bone cement carbon fiber rods loaded with antibiotic-containing calcium sulfate in the proximal femur can effectively decrease inflammatory responses and pain. While eliminating infection, it also affects osteogenic formation. The postoperative recurrence rate decreases considerably, and it has good clinical efficacy.