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The Use of an “Internal Fixator Technique” to Stabilize Pathologic Fractures Developing Secondary to Osteomyelitis

Yildirim, Azad MD; Kapukaya, Ahmet MD; Atiç, Ramazan MD; Mertsoy, Yilmaz MD; Yiğit, Şehmus MD; Çaçan, Mehmet A. MD; Alemdar, Celil MD

Journal of Pediatric Orthopaedics: April/May 2017 - Volume 37 - Issue 3 - p 222–226
doi: 10.1097/BPO.0000000000000619
Selected Topics

Background: There is no consensus on the materials and the techniques to use in fixing pathologic fractures secondary to osteomyelitis. This study reports the results of the fixation of pathologic fractures secondary to osteomyelitis using the “internal fixator technique.”

Methods: The internal fixator technique was performed on 11 children and adolescents with fractures secondary to osteomyelitis between 2003 and 2010. A retrospective chart review was conducted to record the following: age, sex, the anatomic region of infection, the time delay from symptom onset to fracture, the classification of chronic osteomyelitis, the Cierny-Mader classification, the causative organism, surgeries, the length of hospitalization, the location and the pattern of fracture, the duration of infection, the length of follow-up, and complications.

Results: The patients included 7 male and 4 female patients with a mean age of 8.7 (range, 6 to 13) years. Pathologic fractures were as follows: 7 femur and 4 tibia. Nine of them were in the metaphysis and 2 others were located in the diaphysis. The time delay from symptom onset to fracture was 3.36 (1 to 9) months. The anatomic region of infection was the diaphysis in 2 cases and the metaphysis in 9 cases. Fractures patterns were short oblique and transverse. The length of hospitalization was a mean of 7 days. The duration of infection ranged from 1 to 12 (mean, 4.38) months. The mean duration of follow-up was 57.09 (range, 36 to 73) months from the initial presentation. Only 2 patients developed shortening, for which no additional intervention was performed.

Conclusions: This case series demonstrates that the “internal fixator technique” is an acceptable alternative to the management of pathologic fractures of the femur or the tibia in children and adolescents with unresolved acute and chronic osteomyelitis. Infections were resolved in all cases and fractures were sufficiently stabilized to allow union with a low complication rate.

Level of Evidence: Level IV—therapeutic.

*Gazi Yasargil Education and Research Hospital, Orthopaedics & Travmatology Centre

Dicle University, Medical Faculty, Department of Orthopaedics & Travmatology

Sultan Private Hospital, Diyarbakir Turkey

The authors declared that this study has received no financial support.

The authors declare no conflicts of interest.

Reprints: Azad Yildirim, MD, Gazi Yaşargil Education and Research Hospital Orthopaedics & Travmatology, 21280 Diyarbakir, Turkey. E-mail:

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