Infected Non union Fracture Femur

Several problems in this case:

1.       Fist at all, why don’t use an IM Road from the beginning.  It’s so down the fracture for DHS, and I will do an IM Road in these cases.

2.       Why to wait for removal hardware.  After the infection, will be better to remove hardware, ex fix, 6w on AB and then IM Road.

3.       Actually, I will leave with the ex fix 6 – 8w, AB with consultant with infectologist, and then proceed to an IM Road. Locking proximal an distally. In these case, after infection I prefere to use a solid nail, and use the bone defect with Cement with AB.  After 6 – 8 weeks removal of the cement and proceed with bone graft (auto or allo graft).

 Regards.

 Dino Aguilar

Dear Dr. ....
For this case, we like to re-open weekly, clean, wash and do new culture + change the bees and add the
suitable antibiotic to the cement ( custom made bees). Then weekly we do ESR, CRP and notice the change.
Once the investigations came back to the normal average, then we go for a definitive fixation Possible
internal fixation again, or just augment the externa as a definitive fixation. Usually, we do not have to
close the skin completely every time to make it easy the next week to re-open. The process of repated
opening and cleaning could be usually repeated for 3 to 5 times untill the investigation become good and go
for definive fixation. I am interest to know the other doctors opinions, but i have learn this from one of
the best american doctor in management of bone infection cases.
Wish you all the best,
YASSER ELBATRAWY, MD
A.LECTURER OF ORTHOPEDIC SURGERY,
AOAA MEMBER,
ASAMI INTERNATIONAL MEMBER,
ASAMI NORTH AMERICA MEMBER,
EOA MEMBER.

Dear .....:
First don't leave these septopal beads for long time as they are source of infection. When infection
subsided clinically and by lab: ESR and C reactive protein, remove the ex fix and put the patient in a
functional cast brace for at least 5 weeks untill the pin tract sites are clear then put an interlocking
nail under umbrella of antibiotics with bone grfting,

FAHMY SHOUKRY.
Professor of Orthopaedic Surgery and traumatology
Alexandria University-Egypt

External fixation and repeated deebridements with antibiotic cement spacer till infection is controlled. It can take 4-6 weeks. After that closed interlocked nailing could be used for definitive stabilization.
Best regards,
 Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

either treat him with Orthofix external fixation & Ilizarov technique of radical debridment & limb reconstruction. or wait till the CRP & ESR are normal & use medullary titanium nail for the subtrochanteric fractures as Gamma nail or intramedullary hip screw ..etc
 

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