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Page 43
Volume 13
Journal of Orthopaedics Trauma Surgery & Related Research
Arthroplasty 2018
September 24-25, 2018
Arthroplasty
September 24-25, 2018 London, UK
11
th
International Conference on
Jongho Noh et al., J Arthroplasty 2018, Volume 13
Treatment of proximal femur osteomyelitis occurred after proximal femoral nail anti-rotation fixation
with antibiotic cement-coated tibia intramedullary nail: A case report
Jongho Noh, Sehoon Jung and Kee Haeng Lee
Catholic University, Republic of Korea
Introduction:
Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while contributing to
bone stability. We present a case of femoral subtrochanteric fracture in a patient with an infected nonunion who was successfully
treated for an infection and nonunion using an antibiotic cement-coated tibial intramedullary nail.
Case Report:
A 79-year-old woman with a right femoral subtrochanteric fracture underwent internal fixation using Proximal Femoral
Nail Antirotation (PFNA). She developed osteomyelitis with nonunion at the surgical site, 10 months postoperatively. A two-stage
surgery, including removal of the existing PFNA to treat the infection and stable fixation to treat the nonunion, is generally performed
but requires a prolonged hospitalization period. We therefore decided to insert an antibiotic cement-coated intramedullary nail in a
one-stage surgery. However, the patient’s diaphysis of the femur was too shallow to insert the antibiotic cement-coated intramedullary
nail, even when using the smallest femoral intramedullary nail. Stable fixation could not be achieved using an antibiotic cement-
coated intramedullary K-wire, thus, we decided to use an antibiotic cement-coated tibial intramedullary nail. After coating the nail
with bone cement mixed with antibiotics, bone fixation was achieved by inserting the nail at the site of the PFNA. The patient’s
symptoms improved, symptoms from the infection disappeared and bone union was confirmed.
Discussion:
Osteomyelitis occurred because of postoperative infection following a proximal femoral fracture. Antibiotic cement-
coated tibial intramedullary nails are effective option to treat patients with osteomyelitis of the femur and achieve bone union where
nonunion persists with a shallow intramedullary femoral canal.
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