A Phase 4 interventional study of Antibiotic coated intramedullary Nail and Standard Intramedullary Nail in Osteomyelitis Tibia, Tibial Fractures and Open Tibia Fracture, sponsored by Wake Forest University Health Sciences. Recruiting at 15 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-18.
Sponsored by Wake Forest University Health Sciences · Phase 4, Interventional, and Prevention
This prospective randomized clinical trial will compare outcomes between patients treated primarily with a prophylactic antibiotic coated nail and those treated with traditional standard of care intramedullary (IM) nailing.
Despite significant treatment advances and protocols to prevent infection, severe open fractures of the lower extremity still have very high rates of deep infection. Infection in an active duty military population increases disability and decreases the likelihood of returning to duty. In addition, infection is one of the main factors associated with rehospitalization. Further, deep infections have not only resulted in increased disability after injury, infection is implicated as one of the main factors in late amputation. Among service members, only 20-25% with a severe open tibia fracture are able to return to active duty. Novel techniques for reducing infection are needed. The proposed study addresses the focus area of fracture-related infections, specifically the prevention of infection.
This prospective randomized clinical trial will compare outcomes between patients treated primarily with a prophylactic antibiotic coated nail and those treated with traditional standard of care intramedullary (IM) nailing.
This prospective randomized clinical trial will compare outcomes between patients treated primarily with a prophylactic antibiotic coated nail and those treated with traditional standard of care intramedullary (IM) nailing.
The target population for the proposed study is patients with severe open tibia fractures (Type II or Type III) who require definitive fixation with intramedullary nail recruited from one of the participating sites during the index hospitalization.
One group will be treated prophylactically using an antibiotic coated intramedullary nail at time of definitive fixation (1CN), while the second group will be treated with traditional standard of care intramedullary nail without antibiotic-coating (SN).
Participant will be followed for 12 months (data capture including patient interviews and clinical data capture from the treatment team and medical record at baseline, 6 weeks, 3 months, 6 months, and 12 months).
159 studies on the registry are indexed under Tibial Fractures; 40 are open to participants now.
This study's planned enrollment of 242 is above the median of 60 across 105 interventional studies indexed under Tibial Fractures.
Browse Tibial Fractures studies →Wake Forest University Health Sciences is the lead sponsor of 1,320 studies on the registry; 199 are open to participants now.
Of its 323 completed or terminated interventional studies of FDA-regulated products, 243 (75%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Traditional standard of care intramedullary (IM) nail
Other: Standard Intramedullary Nail
Intramedullary Nail coated with 2 grams of vancomycin and 560 mg gentamicin liquid.
Drug: Antibiotic coated intramedullary Nail
Antibiotic coated intramedullary nail: A mixture of 40gm bag of acrylic cement, antibiotic powder (Vancomycin 2gm) and 560mg gentamicin liquid. The intramedullary is coated with the mixture using a cement gun tube.
Also known as: Local Gentamicin 560 Powder, Vancomycin 2gm Liquid
Standard Intramedullary Nail
Number of Participants who develop deep surgical site infection (SSI)
Number of participants in each group who develop SSI as defined by the criteria establish by the Centers for Disease Control and Prevention (CDC). The CDC criteria define deep as occurring within 30 or 90 days after the procedure. However, we will continue to follow patients for 12 months and document any infections and other complications during this period.
Time frame: Day 30 through month 12
Radiographic Union Scale in Tibial fractures (RUST) score
The RUST score ranges from a minimum score of 4 (definitely not healed) to a maximum score of 12 (completely healed). The final x-ray obtained within a 12-month period following injury will be uploaded to REDCap for review by a blinded panel of investigators from participating sites.
Time frame: week 6, month 3, month 6, and month 12
Percentage of Union
Union is the gradual process of bone regeneration after a fracture. Percentage of Union, as determined by the treating surgeon, will be assessed via radiographs. Recorded by surgeon as yes/no answers.
Time frame: week 6, month 3, month 6 and month12
Time to Union
Captured in days
Time frame: week 6, month 3, month 6 and month12
Average Time to Return to Work/Duty
number of days
Time frame: week 6, month 3, month 6 and month12
International Physical Activity Questionnaire (IPAQ)
IPAQ measures the total amount of physical activity completed in a 7 day period by calculating the minutes per week in in each physical activity level domain (walking, moderate and vigorous) by a metabolic equivalent energy (MET) expenditure estimate. Walking = 3.3 x number of walking minutes x number of walking days Moderate activity= 4.0 x number activity minutes x number of days Vigorous activity = 8 x number of activity minutes x number of days Total = Walking MET-min/wk+moderate MET-min/wk+vigorous MET-min/wk
Time frame: week 6, month 3, month 6 and month12
Number of Subjects Who Have Returned to Work
Determined by asking whether subjects have returned to work
Time frame: week 6, month 3, month 6 and month12
Number of Participants who Return to Operating Room (OR)
Time frame: Month 12
PROMIS-29 Subscale--Physical Function
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means higher physical function.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Physical Function: Anxiety
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher level of anxiety.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Depression
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher level of depression.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Fatigue
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher level of fatigue.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Sleep Disturbance
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher level of sleep disturbance.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Pain Interference
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher level of pain interference.
Time frame: week 6, month 3, month 6 and month12
PROMIS-29 Subscale--Ability to Participate in Social Roles and Activities
The PROMIS-29 scales will be scored using a T-score metric method. A score of 50 points represents the population average for each scale, and 10 points represent one standard deviation. Higher scores means a higher ability to participate in social roles and activities.
Time frame: week 6, month 3, month 6 and month12
Plan to share: No
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Wake Forest University Health Sciences