King Fahd Hospital -Medina Munawrah-Orthopedic Surgery Department
Fracture Right Femur
Rt. Ankle and knee stiffness
34 years Saudi male in a road traffic accident
sustained closed fractures of
Rt. Mid-shaft femur.
Rt. Medial femoral condyle (minimally displaced)
Rt. Proximal tibia (undisplaced)
Rt. Pilon fracture.
Treated elsewhere with
ORIF IM nail with proximal interlocking femur and bone grafting.
IM Rush pin in fibula with above knee plaster cast.
After 8 month of initial treatment.
Multiple discharging sinuses at Rt thigh.
Discharging frank pus.
Still bed ridden with above knee back slab.
No history of fever.
No medical co morbidity.
Shortening of Rt. Femur about 2 cm.
Having stiff Rt. Ankle & Knee.
Normal neurovascular examination in Rt lower limb.
Complete Blood count.
ESR 80 mm after 1st hour.
Blood sugar normal.
Liver and Renal functions normal.
C & S from wound swab.
Staph Aureus sensitive to most of the antibiotics.
How to control Infection?
How to get union and to Reconstruct Residual bone defect?
How to Rehabilitate the Patient?
Look what we did
Removal of Implant.
Multiple debridement & curettage.
local Antibiotics, Bone cement beads/sponge.
Systemic Antibiotics for long time.
Temporary skeletal traction to maintain length.
In bed exercises for Knee and Ankle ROM.
Re-fixation with static interlocking Recon nail.
Bone grafting -Autograft mixed with Allograft.
Rehabilitation and follow-up.
Suspected local recurrence of Infection
Planned for Removal of screws, debridement, antibiotic
Dynamization of nail
Finally nail removed . fracture united with almost full range of movement. The patient is completely weight bearing and got back to almost ordinary daily activities .
Mission Accomplished !
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