SEPTIC NONUNION OF THE FEMUR: 11 CASES

C. De La Porte; T. Bégué; P. Thoreux; A.-C. Masquelet

doi:10.1302/0301-620X.87BSUPP_II.0870111

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SEPTIC NONUNION OF THE FEMUR: 11 CASES

C. De La Porte
T. Bégué
P. Thoreux
A.-C. Masquelet

SEPTIC NONUNION OF THE FEMUR: 11 CASES

De La Porte C, Bégué T, Thoreux P, Masquelet A. SEPTIC NONUNION OF THE FEMUR: 11 CASES. Orthop Procs. 2005;87-B(SUPP_II):111-111. doi:10.1302/0301-620X.87BSUPP_II.0870111

De La Porte, C., et al. “SEPTIC NONUNION OF THE FEMUR: 11 CASES.” Orthopaedic Proceedings, vol. 87-B, no. SUPP_II, 2005, pp. 111-111., https://doi.org/10.1302/0301-620X.87BSUPP_II.0870111

De La Porte, C., Bégué, T., Thoreux, P., & Masquelet, A. (2005). SEPTIC NONUNION OF THE FEMUR: 11 CASES. Orthopaedic Proceedings, 87-B(SUPP_II), 111-111. https://doi.org/10.1302/0301-620X.87BSUPP_II.0870111

De La Porte, C., Bégué, T., Thoreux, P. and Masquelet, A. (2005) “SEPTIC NONUNION OF THE FEMUR: 11 CASES.” Orthopaedic Proceedings, 87-B(SUPP_II), pp. 111-111. Available at: https://doi.org/10.1302/0301-620X.87BSUPP_II.0870111

De La Porte, C., T. Bégué, P. Thoreux, and A.-C. Masquelet. “SEPTIC NONUNION OF THE FEMUR: 11 CASES.” Orthopaedic Proceedings 87-B, no. SUPP_II (2005): 111-111. https://doi.org/10.1302/0301-620X.87BSUPP_II.0870111

De La Porte C, Bégué T, Thoreux P, Masquelet A. SEPTIC NONUNION OF THE FEMUR: 11 CASES. Orthop Procs. 2005 Apr 1;87-B(SUPP_II):111-111. https://doi.org/10.1302/0301-620X.87BSUPP_II.0870111

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Abstract

Purpose: The diversity of treatments proposed for septic nonunion of the femur demonstrates the lack of consensus. Treatment modalities validated for the leg appear to be transposable to the femur. The purpose of this work was to compare different treatments used in our centre and identify optimal management practices.

Material and methods: We report a retrospective series of eleven patients (nine men and two women) who developed septic nonunion of the femur subsequent to trauma (n=9) or tumour (n=2). Sepsis developed early in seven cases and late in four. Mean time to treatment was 34.8 months. We based our strategy on a succession of steps starting with cure of the soft tissue and bone infection, before attempting reconstruction and consolidation.The first step involved fixation, antibiotic therapy and interposition of an acrylic spacer. The second step involved bone reconstruction, removal of the spacer, vascularised fibular graft associated with a cancellous bone graft (n=4) or massive cancellous graft inserted into the pseudomembrane created by the spacer (n=7).

Results: Mean time to resolution of the infection was 10.9 months. Cure could not be achieved in three patients. Bone continuity was achieved in 8.8 months on average. The time to bone healing (i.e. duration of external fixation) was 22 months. Refracture occurred in four patients. Consolidation was not achieved in two patients.

Discussion: During the second step, we preferred massive cancellous bone reconstruction due to easier technique, shorter healing time, and better adaptation of the reconstruction volume. Optimal time for the first step is about six months in order to avoid recurrent infection. Our healing times are similar to those reported by others: the healing index (time to healing divided by gap length) was close to that obtained with the compression-distraction technique. Refractures related to specific mechanical problems inherent in the femur lead to longer time for external fixation, minimum 13 months.

Correspondence should be addressed to SOFCOT, 56 rue Boissonade, 75014 Paris, France.