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Management of Infected Nonunited Femoral Fracture With Large Bone Defects

A Technique

Ghaffar, Khalid Abd El, MD; Diab, Ramy, MD; Kotb, Ahmed, MD

doi: 10.1097/BTO.0000000000000296
Novel Research Methods and Models

Background: Segmental defects created after debridement for infected nonunion of long bones can be managed by external fixation and bone grafting, bone transport, or microvascular free-tissue flaps. Distorted local anatomy with a cumbersome Ilizarov frame, recipient site complications, thrombosis, and graft failure are possible complications of trending treatment modalities. Our 2-staged novel technique offers a simpler, easier, lesser money and time-consuming procedure to combat one of the most difficult orthopedic problems.

Patients and Methods: Between January 2012 and January 2014, 12 patients, all were male individuals, enrolled in a prospective study underwent a 2-staged operation for infected nonunited femoral fracture with large bone defects. The first stage included radical debridement and sequestrectomy with rush pin fixation to maintain alignment and medullary patency supported by biplanar or limb reconstruction fixator; the second stage included 4 corticocancellous bone graftings. Follow-up was for a duration of a mean of 24±3.4 months; the mean duration for full union was 9.36±1.6 months. Complications included knee flexion deformity managed by flexion deformity graft and pain at site by iliac crest graft.

Conclusions: Our method of treatment presents a new approach for management of one of the most complicated orthopedic problems ever. Our method is economic, and cost and time saving, consuming less time and materials needed for the operation.

Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

The authors declare that they have nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact Ahmed Kotb, MD, at or by mail at Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, 38 Abbasia, Cairo, Egypt. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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