{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:49:00Z","timestamp":1776732540325,"version":"3.51.2"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Long bone infected non-unions are such an orthopedic challenge that antibiotic-coated intramedullary nailing (ACIN) has become a viable therapeutic option for their management. This study aims to provide a comprehensive assessment of the available data about the use of antibiotic-coated nailing in the treatment of long bone infected non-unions. Following the PRISMA guideline in this meta-analysis, a systematic literature search was conducted across major databases for studies evaluating ACIN in long bone infected non-unions. The primary outcome measures included union rates, infection control, complications and functional status. Five eligible studies encompassing 183 patients in total met the inclusion criteria. The meta-analysis revealed no difference in the union rate in the antibiotic-coated intramedullary nailing group compared to that of the control group (OR = 1.73 [0.75\u20134.02]). Antibiotic-coated intramedullary nailing demonstrated no association with higher infection eradication (OR = 2.10 [0.97\u20134.54]). Also, functional outcome measure was mostly not significantly different between ACIN and control interventions. According to this meta-analysis, compared to the management of controls, ACIN is neither linked to increased union rates nor decreased infection rates. The paucity of research on this topic emphasizes the continuous need for additional well-designed randomized controlled trials for the application of antibiotics-coated intramedullary nailing in long bone non-unions.<\/jats:p>","DOI":"10.3390\/antibiotics13010069","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T07:50:48Z","timestamp":1704873048000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Antibiotic-Coated Intramedullary Nailing Managing Long Bone Infected Non-Unions: A Meta-Analysis of Comparative Studies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4322-0236","authenticated-orcid":false,"given":"Amirhossein","family":"Ghaseminejad-Raeini","sequence":"first","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, 1461884513 Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alireza","family":"Azarboo","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, 1461884513 Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasra","family":"Pirahesh","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, 1461884513 Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amirmohammad","family":"Sharafi","sequence":"additional","affiliation":[{"name":"School of Medicine, Tehran University of Medical Sciences, 1461884513 Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir Human","family":"Hoveidaei","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basilia Onyinyechukwu","family":"Nwankwo","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhijith","family":"Annasamudram","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet D.","family":"Conway","sequence":"additional","affiliation":[{"name":"International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"186","DOI":"10.11138\/ccmbm\/2017.14.1.186","article-title":"Non-unions","volume":"14","author":"Calori","year":"2017","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3200","DOI":"10.1016\/j.injury.2021.09.008","article-title":"Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice","volume":"52","author":"Wittauer","year":"2021","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.injury.2020.11.029","article-title":"Fracture nonunion in long bones: A literature review of risk factors and surgical management","volume":"52","author":"Nicholson","year":"2021","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e162775","DOI":"10.1001\/jamasurg.2016.2775","article-title":"Epidemiology of Fracture Nonunion in 18 Human Bones","volume":"151","author":"Zura","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.2106\/JBJS.RVW.O.00008","article-title":"Biological Risk Factors for Nonunion of Bone Fracture","volume":"4","author":"Zura","year":"2016","journal-title":"JBJS Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"754150","DOI":"10.3389\/fsurg.2021.754150","article-title":"Analysis of Risk Factors for Non-union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects","volume":"8","author":"Quan","year":"2021","journal-title":"Front. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/BOT.0b013e31812e5578","article-title":"Infected nonunion of the long bones","volume":"21","author":"Struijs","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2174\/1874325001307010219","article-title":"Management of infection after intramedullary nailing of long bone fractures: Treatment protocols and outcomes","volume":"7","author":"Makridis","year":"2013","journal-title":"Open Orthop. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"396","DOI":"10.4103\/0019-5413.55468","article-title":"Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones","volume":"43","author":"Shyam","year":"2009","journal-title":"Indian J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e371","DOI":"10.5435\/JAAOS-D-17-00003","article-title":"Use of Intrawound Antibiotics in Orthopaedic Surgery","volume":"26","author":"Chen","year":"2018","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Flores, M.J., Brown, K.E., Morshed, S., and Shearer, D.W. (2022). Evidence for Local Antibiotics in the Prevention of Infection in Orthopaedic Trauma. J. Clin. Med., 11.","DOI":"10.3390\/jcm11247461"},{"key":"ref_12","first-page":"495","article-title":"Applications of Local Antibiotics in Orthopedic Trauma","volume":"46","author":"Cancienne","year":"2015","journal-title":"Orthop. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1016\/j.injury.2022.03.040","article-title":"Use of antibiotic-cement coated locking plates in the setting of periprosthetic infection and infected nonunion","volume":"53","author":"Keller","year":"2022","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.artd.2022.01.023","article-title":"Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study","volume":"14","author":"Tarity","year":"2022","journal-title":"Arthroplast. Today"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Hu, K., Xing, X., Zhang, J., Zhang, M.R., Ma, X., Shi, R., and Zhang, L. (2021). Smart Titanium Coating Composed of Antibiotic Conjugated Peptides as an Infection-Responsive Antibacterial Agent. Macromol. Biosci., 21.","DOI":"10.1002\/mabi.202000194"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5704\/MOJ.1703.019","article-title":"Role of Antibiotic Cement Coated Nailing in Infected Nonunion of Tibia","volume":"11","author":"Bhatia","year":"2017","journal-title":"Malays. Orthop. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1016\/j.injury.2022.05.008","article-title":"Individual and commercially available antimicrobial coatings for intramedullary nails for the treatment of infected long bone non-unions: A systematic review","volume":"53","author":"Walter","year":"2022","journal-title":"Injury"},{"key":"ref_18","first-page":"e29659","article-title":"A Comparative Study of Treatment with External Fixator Versus Antibiotic Coated Intramedullary Nail in Infected Non-union Long Bones","volume":"14","author":"Bakshi","year":"2022","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5194\/jbji-7-101-2022","article-title":"Prophylaxis and treatment of infection in long bones using an antibiotic-loaded ceramic coating with interlocking intramedullary nails","volume":"7","author":"Downey","year":"2022","journal-title":"J. Bone Jt. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Greco, T., Cianni, L., Polichetti, C., Inverso, M., Maccauro, G., and Perisano, C. (2021). Uncoated vs. Antibiotic-Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 according to AO Classification): A Single Center Experience. BioMed Res. Int., 2021.","DOI":"10.1155\/2021\/7421582"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.cjtee.2019.03.006","article-title":"Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures","volume":"22","author":"Pinto","year":"2019","journal-title":"Chin. J. Traumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3464","DOI":"10.1016\/j.injury.2022.08.020","article-title":"Functional and radiological outcomes of primary ring fixator versus antibiotic nail in open tibial diaphyseal fractures: A prospective study","volume":"53","author":"Rohilla","year":"2022","journal-title":"Injury"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e055","DOI":"10.1097\/OI9.0000000000000055","article-title":"Hardware considerations in infection and nonunion management: When and how to revise the fixation","volume":"3","author":"Hoit","year":"2020","journal-title":"OTA Int. Open Access J. Orthop. Trauma"},{"key":"ref_24","first-page":"63","article-title":"Intramedullary antibiotic coated nail in tibial fracture: A systematic review","volume":"34","author":"Greco","year":"2020","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"212","DOI":"10.7150\/jbji.44839","article-title":"Efficacy of antimicrobial coated orthopaedic implants on the prevention of periprosthetic infections: A systematic review and meta-analysis","volume":"5","author":"Savvidou","year":"2020","journal-title":"J. Bone Jt. Infect."},{"key":"ref_26","first-page":"155","article-title":"The Antibiotic Nail in the Treatment of Long Bone Infection: Technique and Results","volume":"48","author":"Koury","year":"2017","journal-title":"Orthop. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1302\/2046-3758.510.BJR-2016-0138","article-title":"The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection","volume":"5","author":"Mills","year":"2016","journal-title":"Bone Jt. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00264-014-2293-2","article-title":"Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing","volume":"38","author":"Craig","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2106\/JBJS.H.00753","article-title":"Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects","volume":"90","author":"Thonse","year":"2008","journal-title":"J. Bone Jt. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1016\/j.injury.2017.04.026","article-title":"Current treatment of infected non-union after intramedullary nailing","volume":"48","author":"Simpson","year":"2017","journal-title":"Injury"},{"key":"ref_31","first-page":"25546","article-title":"Intramedullary nail: The past, present and the future\u2014A review exploring where the future may lead us","volume":"13","author":"Kang","year":"2021","journal-title":"Orthop. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"10225536221118521","DOI":"10.1177\/10225536221118521","article-title":"Antibiotic coated nails: Rationale, development, indications and outcomes","volume":"30","author":"Kalbas","year":"2022","journal-title":"J. Orthop. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.injury.2021.04.053","article-title":"Use of antibiotic coated intramedullary nails in open tibia fractures: A European medical resource use and cost-effectiveness analysis","volume":"52","author":"Franz","year":"2021","journal-title":"Injury"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_35","first-page":"7","article-title":"Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better?","volume":"7","author":"Ma","year":"2020","journal-title":"Mil. Med. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/sim.8781","article-title":"Evaluation of various estimators for standardized mean difference in meta-analysis","volume":"40","author":"Lin","year":"2021","journal-title":"Stat. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:43:46Z","timestamp":1760103826000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,10]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["antibiotics13010069"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13010069","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,10]]}}}