Intermittent Debridement and Nail Change - a Successful Strategy for the Treatment of Acute Osteitis of the Femur

Abstract

IntroductionThe rate of infection after osteosynthesis of long bones is very small. Today most of the fractures of the femur are stabilised with a nail. But a case of acute osteitis after nailing a fracture of the femur seems to be a disaster for the patient and the surgeon. The pathogenesis of acute osteitis is a result of open fractures, iatrogenic failures of operative management and inconsistent management of postoperative complications [1, 4 ± 7]. In 10± 30 % of cases a chronic osteitis develops out of an acute one. The common rate of osteitis after any osteosynthesis of fractured bone is 0.5±1 %. The treatment costs of the chronic osteitis are much higher than the costs for the consequent therapy of the acute osteitis. A single case of the chronic osteitis costs nearly 500 000 Euro. In Germany 1000 cases per year are expected [1].An early and a consequent management is necessary to prevent the development of chronic osteitis from an acute one [8]. Materials and MethodsThe idea was to obtain a fracture healing with good function and without any residue of infection. To realise this concept an early revision of the wound and the bone marrow for reduction of the amount of bacteria was done. This included the removal of the implant during every session. After cleaning the wound, the instruments, gloves and cover were changed and a resterilised implant for stabilisation of the fractured and unstable bone was used. Results83 patients with an acute osteitis were treated from 1998 to 2000. 4 of them (4.9 %) had osteitis of the femur after the nailing procedure of the fracture. The average number of the salvage procedures done was six. No further bacterial growth was found in the marrow hole after the last salvage procedures. The fractured bone was stabilised temporarily with a resterilised nail. In two cases the implant was a gamma nail, in the other two an interlocking-compression nail.In all cases the 16-months follow-up period showed no further infection and the fractures healed with good function. We were able to prevent the development of chronic osteitis by a consequent surgical management in all cases. Case ReportA 23-years-old male with a II8-open fracture of the right femur was admitted to our hospital with Clostridium perfringens in the wound.Therapy: Resection of the infected bone, temporary spacer with cement and stabilisation of the femur with resterilised nail, salvage procedure done 6 times, with the last revision the defect of the bone was filled up with osteocutaneuos flap. AbstractIn cases of acute osteitis, post-osteosynthesis of a fracture of the femur, a consequent therapy is necessary. The goal is to prevent it from developing into a chronic osteitis. We treated 4 patients with the rare cases of acute osteitis of the femur after nailing a fracture. A salvage procedure was done for the reduction of bacteria in the bone and soft tissue on all patients. The average follow-up time of the reported cases was 16 months. The fractures were healed, the function of the leg was good, and we did not find ...