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This intervention is a drug-device combination consisting of an intramedullary (IM) nail coated with a mixture of polymethylmethacrylate (PMMA) acrylic cement and two antibiotics, vancomycin and gentamicin. Developed by Wake Forest University Health Sciences, it is primarily indicated for the prevention of surgical site infections and osteomyelitis in patients with severe open tibia fractures. The vancomycin component targets Gram-positive bacteria by binding to the D-alanyl-D-alanine portion of cell wall precursors, thereby inhibiting peptidoglycan synthesis. Gentamicin provides broad-spectrum Gram-negative coverage by binding to the bacterial 30S ribosomal subunit and inhibiting protein synthesis. This localized delivery system allows for high concentrations of antibiotics at the fracture site while minimizing systemic toxicity.
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