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Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options

The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after p...

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Autores principales: Starčević, Neven, Karačić, Andrija
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464431/
https://www.ncbi.nlm.nih.gov/pubmed/34580614
http://dx.doi.org/10.1155/2021/3530297
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author Starčević, Neven
Karačić, Andrija
author_facet Starčević, Neven
Karačić, Andrija
author_sort Starčević, Neven
collection PubMed
description The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking “classic” plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5 cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances.
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spelling pubmed-84644312021-09-26 Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options Starčević, Neven Karačić, Andrija Case Rep Orthop Case Report The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking “classic” plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5 cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances. Hindawi 2021-09-17 /pmc/articles/PMC8464431/ /pubmed/34580614 http://dx.doi.org/10.1155/2021/3530297 Text en Copyright © 2021 Neven Starčević and Andrija Karačić. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Starčević, Neven
Karačić, Andrija
Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title_full Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title_fullStr Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title_full_unstemmed Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title_short Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options
title_sort infected nonunion of the distal femur in the elderly with bone loss: case report and treatment options
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464431/
https://www.ncbi.nlm.nih.gov/pubmed/34580614
http://dx.doi.org/10.1155/2021/3530297
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