ANTIINFECTIVE EFFICACY OF ANTISEPTIC-COATED INTRAMEDULLARY NAILS

The coating of medical devices with antimicrobial agents has recently emerged as a potentially effective method for the prevention of device -related infections. We examined the anti-infective efficacy of intram edullary nails coated with an antiseptic combination of chlorhexidine and chloroxylenol in a rabbit model of device-related infection after fixation of an open tibial fracture. The rabbits were randomized to re ceive 2.8-by-100-millimeter stainless-steel tibial intramedullary nail s that either were uncoated ol were coated with antiseptic. After admi nistration of anesthesia and preoperative antibiotic prophylaxis, a ti bial fracture was created and then reduced with insertion of the intra medullary nail, A bacterial inoculum of 10(6) colony-forming units of Staphylococcus aureus was injected into the intramedullary canal, and the wound was sutured, Radiographs of the tibiae were made postoperati vely, and the rabbits were monitored daily. They,were killed at six we eks, or earlier if there was dehiscence of the wound, the fracture bec ame grossly unstable, or the rabbit failed to thrive. The use of the a ntiseptic-coated nails was associated with a significantly lower rate of device-related osteomyelitis (two of twenty-two; 9 per cent) than t he use of the uncoated nails (thirteen of twenty-one; 62 per cent) (p = 0.0003), The radiographic and histopathological findings mere genera lly similar in the two groups of rabbits. Antiseptic agents were not d etected in serum, The results suggest that antiseptic-coated fracture- fixation devices provide significant local protection against Staphylo coccus nul eus, which is the most common cause of infections related t o orthopaedic devices.