To investigate the clinical effect of reaming and debridement combined with unilateral external fixator in the treatment of chronic infection after intramedullary nailing of long bone fractures.

The data of 22 patients with chronic infection after treatment with intramedullary nails for long bone fractures of the lower extremity who were treated from January 2014 to January 2018 were retrospectively analyzed. There were 16 males and 6 females; age ranged from 21 to 62 years, with an average of (38.4±9.3) years old; 12 cases of femoral infection and 10 cases of tibial infection. Fifteen of the initial injuries were closed fractures; seven were open fractures. According to the Cierny-Mader classification of bone infection, there were 10 cases of type I (intramedullary type), 7 cases of type Ⅰ+ type Ⅲ (focal type), and 5 cases of type Ⅰ+ type Ⅱ (diffuse type). The intramedullary nails were removed from all 22 patients, and the pulp was reamed, meanwhile the pulp cavity was flushed. The infected and necrotic tissue inside and outside the pulp cavity was completely removed. For those with sinus tract and abscess at the same time, the infected soft tissue should be completely removed together; for those with focal infection, the infected and necrotic bone should be partially excised, and the local bone defect should be rebuilt after the infection was controlled in two stages. Bone transfer treatment were conducted in large bone defect. All patients received intravenous infusion of sensitive antibiotics for 2 weeks, and then changed to oral administration for 4 weeks, for a total of 6 weeks.

Twenty-two patients were followed up for 16-36 months, with an average of (24.5±4.1) months. There was no recurrence of infection or residual infection in 20 patients. One patient had skin and soft tissue infection, and the wound healed after dressing change. One patient had bone exposure and partial skin defect, and the wound improved after local skin flap was transferred to cover the wound. 12 patients with bone defect after infection and debridement, 10 patients underwent bone grafting after infection control to reconstruct bone defect, and 2 patients underwent bone transfer. All patients achieved fracture union.

Reaming and debridement combined with external fixation is an effective method for chronic infection after intramedullary nailing of long bone fractures.