Date: Mon, 29 Apr 2002 18:23:32 +0600
Subject: Gunshot fracture of the femur
A male 25 y.o 3 months ago was fixed by the Ilizarov fixator applied somewhere else for comminuted femoral fracture after low velocity shotgun wound. Wound healed without infection. Knee ROM is only 20 degrees to date. Recent xrays attached. I think about conversion to an intramedullary nail at least to improve knee function.
Pin sites and the femur in general show no signs of infection. L- 5,1x10^9/l, ESR - 27 mm/hr. But 2 weeks ago he reported episode of hyperthermia 39 degrees and pain in the femur. After 2-3 days all signs disappeared with 5 days of i/m cefalexin.
Is now the surgey rational? What additional tests should be performed if any? Should the fixator be removed on the table or prior (how long?) the surgery? What anibiotic is optimal without any confirmed infection agent and for what period before and after the surgery?
THX in advance.
Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Date: Mon, 29 Apr 2002 10:41:16 -0400
From: James Carr
I would be nervous re: intramedullary sepsis. I guess you could remove the fixator under genl anesthesia, currette/culture, and treat with antibiotics appropriately. The nail at some point when things quiet down. I don't plate many femoral shafts, but I would consider a bridge plating along with muscle release. You could even go sub-q with the LISS system. I know that ex-fix followed by plating has been a good option in the tibia, and has not led to high infection rates- something that can't be said with IM nailing after ex-fix.