Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis

Jul 16, 2026

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The study evaluates whether gentamicin-coated intramedullary nails reduce postoperative infection in Gustilo type I and II open tibial shaft fractures. A retrospective cohort of 124 patients (2013–2020) compared non-antibiotic-coated unreamed interlocking nails (62) with gentamicin-coated nails (62) over 12 months. Postoperative infection rates were lower with antibiotic coating (3.2% vs 17.7%, p=0.031). At 6 months, ESR, CRP, leukocyte count, and blood culture differed significantly, with no difference in hemoglobin. The antibiotic group showed improved union at 6 and 12 months, fewer complications, shorter hospital stay, and reduced need for repeat surgery, supported by Level III evidence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

Abstract

Purpose

Methods

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Study design (patient selection and randomization)

European Journal of Trauma and Emergency Surgery (2025) 51:86 [https://doi.org/10.1007/s00068-025-02763-4](https://doi.org/10.1007/s00068-025-02763-4) ORIGINAL ARTICLE Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis S.K. Rai1 · T.P. Gupta2 · Manoj Kashid3 · Bhavya Sirohi4 · Amit Kale5 · Ritesh Sharma2 · Arjun Gandotra6 Received: 25 October 2024 / Accepted: 5 January 2025 / Published online: 27 January 2025 © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2025 Abstract Purpose Tibial open shaft fractures are very common and susceptible to infection, which can lead to significant morbidity especially infection and non-union. Antibiotic coated nail is one option for fixing open shaft tibial fractures to minimise infection. This study aimed to compare the clinical outcome of Gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails in the treatment of type I and II tibial open fractures. Methods Between 2013 and 2020, in a retrospective study of 124 patients with Gustilo type I and II tibial fractures compared non-antibiotic-coated nails (62 patients) with gentamicin-coated nails (62 patients) over 12 months. This study assessed infection rates, duration of hospital stays, fracture union time, and complications. Results The antibiotic nail group had significantly lower postoperative infection rates (3.2%) than the regular nail group (17.7%),(χ2 = 4.64, p = 0.031) . At the 6-month follow-up, significant differences were observed in ESR (p = 0.031), CRP (p = 0.019), leukocyte count (p = 0.0241), and blood culture (p = 0.018), but not in hemoglobin levels (p = 0.067) . The Gentamicin-coated nail group demonstrated better fracture union rates at 6 and 12 months,(p = 0.0267) and lower overall complication rates. Conclusion A tibial nail coated with Gentamicin is an effective method for preventing infection in type I and II open fracture shafts of the tibia. It allows, shortens hospital stay and healing time, prevents infection, and thus reduces the chance of a second surgery. Level of evidence Level III, a retrospective study. Design Retrospective analytical study. Hypothesis We hypothesized that Gentamicin-coated nail is effective in preventing infection in Gustilo type I and II open fractures compared to non-antibiotic-coated regular nails. Keywords Intramedullary nailing · Gentamicin-coated nail · Open tibia fracture · Infection 􀀍 S.K. Rai[skrai47@yahoo.com](skrai47@yahoo.com) [T.P](T.P). Gupta [drtejpratap21@gmail.com](drtejpratap21@gmail.com)[ ](drtejpratap21@gmail.com)Manoj Kashid [manojkashid@yahoo.com](manojkashid@yahoo.com)[ ](manojkashid@yahoo.com)Bhavya Sirohi[drbsirohi@gmail.com](drbsirohi@gmail.com) Amit Kale[dr.amitkale87@gmail.com](dr.amitkale87@gmail.com)[ ](dr.amitkale87@gmail.com)Ritesh Sharma [riteshsharma41083@gmail.com](riteshsharma41083@gmail.com) Arjun Gandotra [restingpeace35@yahoo.com](restingpeace35@yahoo.com) 1 Military Hospital Ambala Cantt, Ambala, Haryana 133001, India 2 Base Hospital, Delhi Cantt, New Delhi 110010, India 3 SMBT Medical Collage Igatpuri, Nashik, Maharashtra 422402, India 4 Military Hospital, Agra, UP 282001, India 5 Military Hospital, Jammu 180003, India 6 Dr C Lal Hospital, Ambala Cantt, Haryana 133001, India Introduction Infections, common in open fracture surgery, depend on fracture type, contamination, and soft tissue damage. Managing bone infections with implants is challenging, often requiring implant removal, debridement, revisions, and long-term antibiotics in severe cases. Open fractures ofthe tibia and fibula are among the most common fractures in orthopedics, frequently resulting from roadside accidents [1–3]. Due to its superficial location just beneath the skin, an open tibial fracture is highly susceptible to infection. Bone infections can lead to mor

FAQs

What was the main objective of the study?

To compare clinical outcomes of gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails for Gustilo type I and II open tibial fractures, focusing on postoperative infection prevention and recovery metrics.

How many patients were included and how were the groups formed?

A retrospective study included 124 patients with Gustilo type I and II tibial fractures, with 62 patients receiving non-antibiotic-coated nails and 62 receiving gentamicin-coated nails, followed for 12 months.

What outcomes showed significant improvement with gentamicin-coated nails?

Postoperative infection rates were significantly lower with gentamicin-coated nails. At 6 months, ESR, CRP, leukocyte count, and blood culture also differed significantly, and fracture union at 6 and 12 months was better with fewer overall complications.

Jul 16, 2026

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