Sonication of Intramedullary Nails: Clinically-Related Infection and Contamination

J Esteban1, 3, E Sandoval2, 3, J Cordero-Ampuero4, D Molina-Manso1, A Ortiz-Pérez1, R Fernández-Roblas1, 3, E Gómez-Barrena*, 5
1 Departments of Clinical Microbiology, IIS-Fundacin Jimnez Daz, Madrid, Spain
2 Departments of Orthopaedics, IIS-Fundacin Jimnez Daz, Madrid, Spain
3 Departments of Bone and Joint Infection Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
4 Department of Orthopaedics, Hospital de la Princesa, Madrid, Spain
5 Department of Orthopaedics, IdiPaz-Hospital La Paz Institute for Health Research, Madrid, Spain

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© Esteban et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Servicio de COT-A-1ª Planta Hospital de Traumatología, Hospital La Paz, Pº Castellana 261, Madrid 28046, Spain; Tel: +34917277085; E-mails:


Background and Aim:

Sonication is currently considered the best procedure for microbiological diagnosis of implant-related osteoarticular infection, but studies in nail-related infections are lacking. The study aim was to evaluate implant sonication after intramedullary nail explantation, and relate it to microbiological cultures and clinical outcome.

Patients and Methods:

A study was performed in two University Hospitals from the same city. Thirty-one patients with implanted nails were prospectively included, whether with clinical infection (8 cases) or without (23 cases). Retrieved nails underwent sonication according a previously published protocol. The clinical and microbiological outcome patient was related to the presence of microorganisms in the retrieved implant.


Positive results appeared in 15/31 patients (9 with polymicrobial infections) almost doubling those clinically infected cases. The most commonly isolated organisms were Staphylococcus epidermidis (19.2 %) and Staphylococcus aureus (15.4 %). A significant relationship was found between the presence of positive cultures and previous local superficial infection (p=0.019). The presence of usual pathogens was significantly related to clinical infection (p=0.005) or local superficial infection (p=0.032). All patients with positive cultures showed pain diminution or absence of pain after nail removal (15/15), but this only occurred in 8 (out of 16) patients with negative cultures.


In patients with previously diagnosed infection or local superficial infection, study of the hardware is mandatory. In cases where pain or patient discomfort is observed, nail sonication can help diagnose the implant colonization with potential pathogens that might require specific treatment to improve the final outcome.

Keywords: Intramedullary nail, orthopaedic infection, sonication, infection diagnosis, nail removal, implant-related infection.