Gentamicin-coated Tibia Nails: Can We Afford NOT to Use Them?

The operative treatment of fractures has made enormous progress over the last decades. Nevertheless, fracture treatment remains a challenge for surgeons, and in particular, the more complicated fractures still harbor the potential for complications that cannot be underestimated. To improve prophylaxis against bacterial colonization of the implant surface, local delivery of antibacterial substances is an effective and promising option. In recent years, a fully resorbable coating for intramedullary nails was developed for the delivery of active substances such as antibiotics to the implantation site. This coating leads to antibiotic concentrations well above the minimal inhibitory concentration of the most commonly encountered bacterial strains in the immediate surroundings of the implant. On the basis of promising data from animal studies, an intramedullary tibial nail with antibiotic coating was developed and approved for clinical use in European countries. The first such implant (UTN PROtect) was released in 2005 and subsequently investigated in a prospective case series, where it proved to be an useful tool in the treatment of tibial fractures in patients presenting a higher risk of developing implantrelated infections. Since 2011, a tibial nail of the latest generation design with the same coating is available (Expert Tibial Nail PROtect) and is being used on a broader scale.