Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review

Molecules. 2020 Nov 23;25(22):5471. doi: 10.3390/molecules25225471.


The incidence of a fracture-related infection (FRI) can reach 30% of open tibia fractures (OTF). The use of antibiotic-coated implants is one of the newest strategies to reduce the risk of infection in orthopedic surgery. The aim of this study was to investigate the efficacy and safety of a gentamicin-coated tibia nail in primary fracture fixation (FF) and revision surgery (RS) of nonunion cases in terms of FRI incidence. We conducted a systematic review according to the PRISMA checklist on Pub-Med, Cochrane, and EMBASE. Of the 32 studies, 8 were included, for a total of 203 patients treated: 114 were FF cases (63% open fractures) and 89 were RS cases, of which 43% were infected nonunion. In the FF group, four FRI were found (3.8%): three OTF (Gustilo-Anderson III) and one closed fracture; bone healing was achieved in 94% of these cases. There were four relapses of infection and one new onset in the RS group; bone healing occurred in 88% of these cases. No side effects were found. There were no significant differences in terms of FRI, nonunion, and healing between the two groups. Gentamicin-coated tibia nail is an effective therapeutic option in the prophylaxis of high-risk fracture infections and in complex nonunion cases.

Keywords: coating; complication; fracture-related infection; gentamicin; intramedullary nailing; nonunion; osteomyelitis; tibia fracture.

Publication types

  • Systematic Review

MeSH terms

  • Animals
  • Bone Nails*
  • Coated Materials, Biocompatible / chemistry*
  • Gentamicins / administration & dosage
  • Gentamicins / chemistry*
  • Humans
  • Osteomyelitis / etiology
  • Osteomyelitis / prevention & control
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Surgical Wound Infection / prevention & control*
  • Tibial Fractures / complications
  • Tibial Fractures / surgery*


  • Coated Materials, Biocompatible
  • Gentamicins