[SPAM detected YNYN Spam-Test: True ; 6.1 / 5.0] INFECTED NON-UNION OF TIBIA-FIBULA

[Dr. Amal Basak]

Dear Doctors,

 

This male patient aged 30 yrs came to me with INFECTED NON-UNION OF TIBIA-FIBULA with discharging sinus on 4.2.2010. He had open # T/F (Gustilo II-B type)  on 4.10.08 and was operated ( I/L of tibia by Titanium nail) by  my colleague here and later on  got infected and ultimately the nail was removed in Sept 2009. What to do now? Sending some x-rays as attachment.

 

  1 ? Illizarov ring fixation with gradual compression

  2 ?      "         "        "          "     corticotomy

  3 ? reaming and re-nailing

  4 ? curettage + locking plate + B/G

 

Please give your valuable opinion. 

 

DR. AMAL BASAK
Orthopaedic Surgeon
Paramount Hospital: Siliguri- 734405
West Bengal : INDIA
Mob:-09474354522

[Alexander Chelnokov]

Hello

2010/2/6 Dr. Amal Basak <amal_...@dataone.in>

 

on  got infected and ultimately the nail was removed in Sept 2009. What to do now? Sending some x-rays as

I'd use temporary antibiotic cement rod + ex-fix for 4-6 weeks then AB cement coated locked nail.
 

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

[dranil...@indiatimes.com]

I will do excision of dead ends (if any) open the medullary canal & fix it with ilizarov apparatus if required corticotomy also for bone transport.

Dr.Anil Mahajan

Indore

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[prof eid]

Hello

 Alexander Chelnokov <ale...@gmail.com> wrote:

........... then AB cement coated locked nail.

Dear Alex
I have read about this technique in J Orthop Trauma, but have you personally used it? In how many cases? and what were your results?
My concern is that after antibiotic elution ends, the cement is no more than another dead foreign body that may in itself harbour infection.
I  would prefer the Ex Fix + Intramedullary cement rod. Then after infection dries out you can remove the cement rod and keep the fixator or remove both and put your choice for definitive fixation.
Best wishes

-

Abdelsalam EID, M.D.
Assistant Professor Orthopaedic Surgery
Zagazig University, EGYPT.

[Dr. Amal Basak]

Dear Sir,

 

How I will know whether the fractured ends are viable or not?  Xray picture looks the # ends are viable.

 

DR. AMAL BASAK
Orthopaedic Surgeon
Paramount Hospital: Siliguri- 734405
West Bengal : INDIA
Mob:-09474354522

----- Original Message -----

From: CHERRY KOVOOR

To: indi...@googlegroups.com

Sent: Monday, February 08, 2010 11:13 AM

Subject: Re: [indiaorth:18464] [SPAM detected Spam-Test: True ; 7.1 / 5.0]INFECTED NON-UNION OF TIBIA-FIBULA

amal

what you have to determine here is if the # ends of the tibia are viable

If they are then monofocal Ilizarov with compression. If not viable then resect dead bone and bifocal Ilizarov with proximal corticotomy AND transport

DR C CHERIAN KOVOOR
KOCHI
INDIA

On Mon, Feb 8, 2010 at 8:56 AM, Dr. Amal Basak <amal_...@dataone.in> wrote:

Dear Doctors,

 

This male patient aged 30 yrs came to me with INFECTED NON-UNION OF TIBIA-FIBULA with discharging sinus on 4.2.2010. He had open # T/F (Gustilo II-B type)  on 4.10.08 and was operated ( I/L of tibia by Titanium nail) by  my colleague here and later on  got infected and ultimately the nail was removed in Sept 2009. What to do now? Sending some x-rays as attachment.

 

  1 ? Illizarov ring fixation with gradual compression

  2 ?      "         "        "          "     corticotomy

  3 ? reaming and re-nailing

  4 ? curettage + locking plate + B/G

 

Please give your valuable opinion. 

 

DR. AMAL BASAK
Orthopaedic Surgeon
Paramount Hospital: Siliguri- 734405
West Bengal : INDIA
Mob:-09474354522

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[taha hussain]

HELLO EVERYBODY,

 

I would prefer to  open the fracture , debride the area, excise the sclerosing edges if any, if the gap is around 2 cms i will dock it,fix it with illizarov and do proximal corticotomy.

 if gap is more after debridement i will do transport without complete docking.

best wishes

Taha Hussain Mir

ORTHO SURGEON

RIYADH.

--

[Alexander Chelnokov]

Yes, we use coated nails about 3 yefyars with expected results. You
are right that not in every case infection is eradicated. But even
after AB is exhausted the cement continues to be a spacer. It can be
replaced with another one sooner or later. Such a nail can be used
primarily or after some I&D or after spacer + XF as you mentioned.
N.C.Lopes prefers to inject cement into the nail with predrilled
holes.
I'll try to present a case these days.

[DR PANKAJ KUMAR]

dear sirs

i m  pankaj kumar. the case which has been put, had been done by me earlier. some of the x rays in the series are missing. i m adding these x rays to the series. i want to point out that i have already done antibiotic cement rod after reaming with large diameter reamer in this case without success. these r the xrays. my experience in this case says that perhaps intramedullary fixation will not be a very wise option. of course this is my personal opinion. i was planning ring fixator.

 

pankaj kumar

ortho surgeon

siliguri

west bengal

india

--

[M.Mahran]

dear all

if u do excision , its not recommended to do acute docking with infection

segement transfere will be safer

--
Mahmoud A. Mahran. M.D., MRCS (England)
Pediatric Orthopedics
limb lengthening, reconstruction and deformity correction
lecturer of Orthopedic surgery
Ain Shams University, Cairo-Egypt.
Fellow of Monash Uni. Melbourne, Australia.
Fellow of Istanbul Uni. Istanbul, Turkey.

Office:  Heliopolis, 15 Al-khalifa El-Mamoon st.
Mobile: 0100689100
Land line: +20222912133
Secretary: +20195643327

[Felix Albers]

Dear Colleagues,

 

I´m joining in late. Correct me if I´m wrong: 30 y.o. male with an open tib-fib fracture in oct/2008 (Gustillo 2). Initial treatment with intramedullary nailing wich was complicated by infection and draining sinus. Next operative intervention in sep/2009 with removal of the nail. From sep/2009 until now reaming + intramedullary lavage + rod made of cement + antibiotics without effect.

 

Now: oligotrophic infected pseudoarthrosis.

 

I have some very basic questions that would help guide treatment:

- where is the infection? in the whole intramedullary canal? in dead bone in the pseudoarthrotic area? could a localized infection be spreaded by reaming?

- in case of a localized infection, resection of the pseudoarthrosis + corticotomy and transport could work, but intramedullary antibiotic spacer would certainly be ineffective.

- in case of diffuse intramedullary infection, corticotomy and transport wouldn´t do it either. is there dead intramedullary or cortical bone that needs to be resected?

- when you have post-operative infection following a tibial nail used in an open fracture, do you consider the whole canal to be infected or just the fracture site wich was exposed?

 

I guess the ideal treatment depends on how you understand the current infectious condition.

Thanks for your answers!

 

Felix

 

 

2010/2/10 DR PANKAJ KUMAR <drp...@gmail.com>

[harpal selhi]

Dear Pankaj,

What volume of cement and what antibiotics and what amount of antibiotics were used. Your nail seems to be too thin to have meaningful cement volume and stability.

Waiting for your answers

Regards

harpal

http://www.orthogate.org <http://www.orthogate.org/>

Dr Harpal Singh Selhi
Associate Professor,
Deptt. Of Orthopedic Surgery,
DMC & Hospital,
Ludhiana-141002  INDIA
Cell: +91-98150-22527
Fax : +91-161-4622527

[Dr. Amal Basak]

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[Alexander Chelnokov]

Hello

2010/2/10 DR PANKAJ KUMAR <drp...@gmail.com>

rays in the series are missing. i m adding these x rays to the series. i want to point out that i have already done antibiotic cement rod after reaming with large diameter reamer in this

If infection has not been wiped out after the first attempt it doesn't mean eventual failure of the approach. Spacer should be replaced with a new one. Maybe also antibiotic has to be changed. If a focus of infection outside the spacer zone found it should be debrided.  Also XF should be applied with such spacer/rod .