Figure 3.

A clinical case of a 27-year-old woman with infected nonunion of the tibia after open fracture (A). She underwent initial irrigation and debridement with removal of hardware and placement of an antibiotic nail, antibiotic beads, and external fixation (B). The beads are ideal in this scenario for maximal surface area and antibiotic elution. At the same time, the antibiotic nail provides stability and local antibiotic delivery in the intramedullary space. A repeat debridement was performed with the placement of a mono-block spacer in the subsequent procedure (C). The mono-block spacer has the advantage of inducing a membrane for subsequent bone grafting and improved structural integrity. Healing of the fracture is shown after bone grafting with the placement of a new intramedullary nail (D).