Detaillierte Beitrags-Information
| Beitragstitel | Fracture on a septic nonunion after an intramedullary nailing of the proximal femur: two-stage implantation. A case report. |
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| Beitragscode | P086 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction Septic nonunion care in the presence of implant requires special attention. These cases may be difficult to diagnose in the event of an acute fracture and cannot be treated easily. We hereby present the case of an acute fracture on a septic nonunion area consecutive to an intramedullary nailing. Case report A 59-year-old woman was referred to the emergency department following a fall from her height on her left side. The X-rays showed a fracture of the proximal femur around an intramedullary nail that was implanted 10 years ago. Following the surgery, our colleagues performed a debridement and gave the patient antibiotic therapy for an infection by coagulase-negative Staphylococci. For this reason, we suspected a chronic infection of the nail; we consequently decided to treat this fracture with a two-stage revision surgery. The first stage after reducing the fracture was to replace the nail by an antibiotic-loaded cemented spacer. Making a cemented spacer adapted to the shape of the Gamma nail was particularly challenging, that is why it was assembled in three parts: the longer part for the femoral shaft, a shorter one in the neck and another one into the most proximal shaft. Preoperatively we noticed a site of nonunion in the line of the acute fracture, and the cultures of the different samplings from both the nonunion and the shaft identified a Staphylococcus hominis. The antibiotic therapy began postoperatively and 4 weeks later we could proceed to the second stage: the re-implantation of a long Gamma nail with a revision of the nonunion by allograft. At 6 months followup, the patient was able to walk with two crutches, without any pain and the x-rays showed bone consolidation. Conclusion In case of a fracture following an implantation, it is very important to take the patient history into account, particularly with infections. In those situations, implant removal and the decision of its replacement in one or two steps combined with adequate antibiotic therapy is essential. The implant design may be a challenge to consider before making the cemented spacer in order to maximise the treatment’s beneficial results. |