Preliminary outcomes of a novel metal-coated antibacterial nail in Bone Transport Over Nail (BTON) and Nail After Bone Transport (NABT) procedures in cases of segmental infected tibial bone defects
Corona Pérez-Cardona, Pablo S (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Pujol, Oriol (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García Valcárcel, Jorge (Hospital Universitari Vall d'Hebron)
Vicente Gomà-Camps, Matías (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Lakhani, Kushal (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Amat, Carles (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Date:	2025
Abstract:	Objective: To evaluate the clinical outcomes of a novel hybrid bone transport technique using an antibacterial-coated nail for the treatment of infected segmental tibial bone defects. Methods: This retrospective study included 19 patients with infected segmental tibial bone defects treated using hybrid bone transport with an antibacterial-coated nail, the ZNN™ Bactiguard® nail. Patients were divided into two groups: nailing after bone transport (NABT, n = 11) and bone transport over nail (BTON, n = 8). These groups were compared with a control group of 10 infected patients treated with conventional external fixation bone transport (EFBT). The primary endpoint was infection eradication, while secondary endpoints included external fixation time (EFT), external fixation index (EFI), complications, and bone regeneration quality. Results: The mean external fixation time (EFT) for the entire cohort was 280. 2 ± 142. 7 days. The BTON group had the shortest EFT (150 ± 45 days), significantly lower than both NABT (279 ± 99 days) and EFBT (927 ± 1710 days, p = 0. 001). The external fixation index (EFI) was also significantly lower for BTON compared to EFBT (25 ± 10. 7 vs. 77. 5 ± 38. 7 days/cm, p = 0. 009). A single case of a recurrent infection was reported in the BTON group (5. 3 %), which was managed with nail removal and the continuation of external fixation bone transport without further complications. The infection was fully resolved in all cases (29/29) at the end of the follow-up period. Complication rates were similar across groups. The primary docking site union rate was 89. 7 %, with no significant differences between groups. Conclusions: The BTON technique using an antibacterial-coated nail reduces EFT by threefold compared to traditional external fixation bone transports methods, without increasing complications. A notable reduction was also observed in the NABT group, although it did not reach statistical significance. This approach offers a promising alternative to conventional methods for the treatment of infected tibial bone defects.
Rights:	Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.
Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Subject:	Bone defect ; Fracture-related infection ; Bone Transport ; Ilizarov technique ; Truelok ; Intramedullary Nail ; Infection complications ; Bactiguard
Published in:	Injury, Vol. 56 Núm. 8 (June 2025) , ISSN 1879-0267

DOI: 10.1016/j.injury.2025.112520

Available from: 2026-06-30 Postprint

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