A 31-years old male went through a complex scenario of a simple middle third fracture Femur through infection and multiple unwise unplanned decisions.
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3. Male patient
31 years old
Medically free, Non smoker
History started in April 2015 after RTA
Open G2 Middle third Left Fracture Femur
First Xray is missed
4. 3 weeks post-operative AP
view available.
Puss discharge started a few
days prior to the x-ray.
Debridement was done but the
puss returned 4-5 weeks after
debridement
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5. • Plate removed
• Debridement
• LRS Ex-Fix applied
in August 2015.
• No infection signs
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6. • LRS Removed in January
2016
• Active sinus tract just at
the Fracture site
• Debridement
• Patient was advised to
start Weight Bearing.
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7. The patient had a
refracture to His
Left Femur
April 2016
Missing the X-ray
9. • Ilizarov Removed in December 2016
• No signs of infection
• No discharge after Frame removal
• Sound union Xray
• No pain with Weight Bearing
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10. • August 2020 (3.5 years after union)
• LLD 4cm
• Gait abnormality
• Severe Low Back Pain.
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11. • Patient had acute Lengthening by
nail and iliac autograft.
• Infection and puss drained 2
months postoperative.
• Nail was removed and debridement
in February 2021
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12. • June 2021 Lt femur was clinically
calm ( No discharge, No warmness)
• Patient underwent a Novel femoral
Lengthening technique with fibular
anchoring and LRS
13. • Due to infection and active discharge
debridement and long Leg Back Slab were
done.
• Patient presented in January 2022
• Infected , Non united and LLD 6 cm.
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22. • United femur
• No LLD (9 cm lengthened)
• stiff knee (0-20) even after aggressive prolonged
physiotherapy (planned for Judet Quadricepse plasty)
Recent status
23. Take home Message
Respect the soft tissue (less ST dissection is Less infection)
Once infected don’t mask it with antibiotics
Acute infection Debride deep ST cultures implant exchange
S Steinmentz et al 2019
24. Pain on Weightbearing is a sign of Non-union in lower limb
LLD more than 2 cm is not favored due to consequences
Never hesitate to refer or higher consult.
(AV Christiano et al 2016)
(Grill F et al 1999, Vitale MA et al 2006)
Ex-Fix is not a Joy card, stick to principles
Fracture alignment
Rotation
LLD
Stability (Schanze numbers and diameter, rods ..etc)
Sabharwel et al 2005