Date: Fri, 30 May 2003 01:30:18 +0000

From: Jeff Richmond

Subject: Infected Femur Malunion

Thanks to everyone for the advice on my last infection. Here is another one.

50 year old male from South America 2.5 years out from an apparent supracondylar femur fx treated with some combination of an ex-fix and internal fixation. Had drainage that ceased at some point. Now has a 40deg flexion contracture with pain. Bone scan shows diffuse uptake throughout his distal femur, WBC 9k, ESR 29, CRP 20. Has had no drainage or fevers for at least 6 months.

He is miserable and wants an operation.

Given that he is still infected based on bone scan and CRP, is resection and Ilizarov his only option for limb salvage or is a knee fusion with an osteotomy and internal fixation possible?

Thanks.

Jeff Richmond
North Shore University Hospital
Manhasset, New York

Date: Thu, 29 May 2003 20:32:25 -0700

From: Tom Toal

Looks like his knee joint is not functioning well

Think about a femoro-tibial nail Once the fracture heals you can remove it.

Smith+Nephew makes one that they can ship in less than 24 hours, comes in 70.75,80 cm sizes

Tom Toal

Date: Fri, 30 May 2003 05:37:56 -0500

From: Obremskey, William T

What is his knee ROM and is it painful?

Bill

William T Obremskey MD MPH
Vanderbilt University
Orthopedic Trauma Division
Nashville, TN 37232-3450

Date: Fri, 30 May 2003 17:50:55 +0600

From: Alexander Chelnokov

Hello Jeff,

JR> Ilizarov his only option for limb salvage or is a knee fusion with an JR> osteotomy and internal fixation possible?

Couldn't total knee arthroplasty with an "oncological" long femoral stem be an option here? Maybe with resection of the distal femur with antibiotic-impregnated spacer as a first step?

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Date: Fri, 30 May 2003 12:56:44 +0000

From: Jeff Richmond

What is his knee ROM and is it painful?

Motion is about 40-80 and painful.

Date: Fri, 30 May 2003 09:09:59 EDT

From: Tadabq

I would consider approaching this in stages. The first stage might be an open biopsy of the most and least suspicious areas of his distal femur for culture & sensitivity including unusual organisms. Make a gross assessment of the bone quality. I might also release scar to try to get his knee straight.

The second stage might be a knee fusion nail.

Tom DeCoster

Date: Sun, 1 Jun 2003 02:11:55 EDT

From: Aobonedoc

Having never done a knee fusion in practice (nearly seven years), I vote for a knee fusion. Severe knee joint arthritis most likely itself will be very painful even if you cure his infection and rotate his femur.

Good luck.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005