Treatment of femur re-fracture with occult infection by using non-contact locking plate under deep fascia_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LI Meng , LAN Xu , ZENG Ping , LI Zhiling , GAO Qiuming , GAO Jie

Department of Orthopaedic Trauma, Lanzhou General Hospital of Lanzhou Military District, Lanzhou Gansu, 730050, P.R.China;

Corresponding?author：

LI Meng, Email: lilionli@126.com

Keywords：

Femoral fracture; internal fixation; infectivity; bone transplantation

DOI：

10.7507/1002-1892.201707107

Video：

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Objective To investigate the effectiveness on the re-fracture of the femur with occult infection by using non-contact locking plate which was placed under the deep fascia. Methods Clinical data of 12 cases of occult infective re-fracture after femoral fracture operation were retrospectively analysed between January 2010 and December 2014. There were 8 males and 4 females with an age of 28-69 years (mean, 42.8 years). Femur re-fractured in 5 cases after 3 days to 4 weeks (mean, 10.6 days) of removal of internal fixation, including 4 cases of plate fixation and 1 case of intramedullary nail fixation; femur in 7 cases re-fractured because of breakage of internal fixator after 7-16 months (mean, 9.3 months) of internal fixation, including 5 cases of plate fixation and 2 cases of intramedullary nail fixation. The tissues near the fracture were collected for bacteria culturing and pathological examining. All the patients were treated by debriding the site of the fracture, bridging with the non-contact locking plate, and transplanting with granulated cancellous bone autograft. Intravenous infusion of antibiotics were used for 2-3 weeks after operation and oral administration for 4 weeks. The X-ray films were taken regularly and the function of the knees were evaluated by the Hospital for Special Surgery (HSS) score system. Results The results of bacteria culturing were positive in 8 patients and negative in 4 patients, and the pathological results of all the patients were confirmed to be chronic bone infection. All the fractures healed with no signs of exudation and ulceration of the incisions. The 12 patients were followed up 18-36 months (mean, 29.6 months). The fracture healed well and no re-fracture occurred. The fracture healing time was 14-22 weeks (mean, 18 weeks). At last follow-up, the function of the knee joint was excellent in 9 cases and good in 3 cases according to HSS score system. Conclusion The treatment of re-fractures after femur fracture operation needs to determine whether there is an occult infection, and non-contact locking plate placed under the deep fascia is an effective way for the re-fracture.

Citation： LI Meng, LAN Xu, ZENG Ping, LI Zhiling, GAO Qiuming, GAO Jie. Treatment of femur re-fracture with occult infection by using non-contact locking plate under deep fascia. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 25-30. doi: 10.7507/1002-1892.201707107 Copy

1.	涂澤松, 李逸群, 吳峰. 股骨骨折鋼板取出后再骨折的病理學觀察. 中國骨傷, 2010, 23(8): 609-611.
2.	Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg, 2006, 14(2): 113-120.
3.	儲為民, 王宇知, 程向國. 股骨干骨折術后鋼板周圍再骨折原因分析及治療體會. 臨床骨科雜志, 2011, 14(3): 328, 331.
4.	陳長青, 丁真奇, 郭林新, 等. 鋼板結合異體骨板治療股骨干內固定術后再骨折. 中國骨傷, 2008, 21(2): 111-112.
5.	Motsitsi NS. Management of infected nonunion of long bones: the last decade (1996-2006). Injury, 2008, 39(2): 155-160.
6.	Stucken C, Olszewski DC, Creevy WR, et al. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg (Am), 2013, 95(15): 1409-1412.
7.	劉林濤, 馬寶通, 葉偉勝. 股骨干骨折內固定術后隱性感染致骨不連. 中華骨科雜志, 2006, 26(2): 132-133.
8.	孔志剛, 于海泉. 骨折內固定術后隱性感染致骨折不愈合及愈合不良的臨床分析. 中華創傷外科雜志, 2010, 12(3): 212-216.
9.	Howe TS, Ehrlich GD, Koh JS, et al. A case of an atypical femoral fracture associated with bacterial biofilm－pathogen or bystander? Osteoporos Int, 2013, 24(5): 1765-1766.
10.	Palmer MP, Altman DT, Altman GT, et al. Can We Trust Intraoperative Culture Results in Nonunions? J Orthop Trauma, 2014, 28(7): 384-390.
11.	Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg (Am), 2014, 96(5): 430-436.
12.	Douraiswami B, Dilip PK, Harish BN, et al. C-reactive protein and interleukin-6 levels in the early detection of infection after open fractures. J Orthop Surg (Hong Kong), 2012, 20(3): 381-385.
13.	章瑩, 朱昌榮, 肖進, 等. 鎖定加壓鋼板外置在脛骨感染性骨不連治療中的應用. 中華創傷骨科雜志, 2013, 15(7): 563-566.
14.	Kloen P. Supercutaneous plating: use of a locking compression plateas an external fixator. J Orthop Trauma, 2009, 23(1): 72-75.
15.	Tulner SA, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop, 2012, 36(9): 1923-1927.
16.	石展英, 趙良軍, 李百川, 等. 鎖定加壓鋼板外固定治療股骨遠端骨折術后感染. 中華實驗外科雜志, 2014, 31(7): 1601-1602.
17.	Alemdar C, Azboy I, Ati? R, et al. Management of infectious fractures with " Non-Contact Plate” (NCP) method. Acta Orthop Belg, 2015, 81(3): 523-529.
18.	Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1): 97-102.
19.	陸維舉, 李斌, 曾曉峰, 等. 清創后Ⅰ期植骨治療慢性骨髓炎的遠期療效. 中華創傷雜志, 2009, 25(12): 1090-1092.
20.	Biz C, Iacobellis C. Nailing treatment in bone transport complications. Strategies Trauma Limb Reconstr, 2014, 9(2): 89-96.
21.	Liodakis E, Kenawey M, Krettek C, et al. Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes. Int Orthop, 2011, 35(9): 1397-1402.

1. 涂澤松, 李逸群, 吳峰. 股骨骨折鋼板取出后再骨折的病理學觀察. 中國骨傷, 2010, 23(8): 609-611.
2. Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg, 2006, 14(2): 113-120.
3. 儲為民, 王宇知, 程向國. 股骨干骨折術后鋼板周圍再骨折原因分析及治療體會. 臨床骨科雜志, 2011, 14(3): 328, 331.
4. 陳長青, 丁真奇, 郭林新, 等. 鋼板結合異體骨板治療股骨干內固定術后再骨折. 中國骨傷, 2008, 21(2): 111-112.
5. Motsitsi NS. Management of infected nonunion of long bones: the last decade (1996-2006). Injury, 2008, 39(2): 155-160.
6. Stucken C, Olszewski DC, Creevy WR, et al. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg (Am), 2013, 95(15): 1409-1412.
7. 劉林濤, 馬寶通, 葉偉勝. 股骨干骨折內固定術后隱性感染致骨不連. 中華骨科雜志, 2006, 26(2): 132-133.
8. 孔志剛, 于海泉. 骨折內固定術后隱性感染致骨折不愈合及愈合不良的臨床分析. 中華創傷外科雜志, 2010, 12(3): 212-216.
9. Howe TS, Ehrlich GD, Koh JS, et al. A case of an atypical femoral fracture associated with bacterial biofilm－pathogen or bystander? Osteoporos Int, 2013, 24(5): 1765-1766.
10. Palmer MP, Altman DT, Altman GT, et al. Can We Trust Intraoperative Culture Results in Nonunions? J Orthop Trauma, 2014, 28(7): 384-390.
11. Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg (Am), 2014, 96(5): 430-436.
12. Douraiswami B, Dilip PK, Harish BN, et al. C-reactive protein and interleukin-6 levels in the early detection of infection after open fractures. J Orthop Surg (Hong Kong), 2012, 20(3): 381-385.
13. 章瑩, 朱昌榮, 肖進, 等. 鎖定加壓鋼板外置在脛骨感染性骨不連治療中的應用. 中華創傷骨科雜志, 2013, 15(7): 563-566.
14. Kloen P. Supercutaneous plating: use of a locking compression plateas an external fixator. J Orthop Trauma, 2009, 23(1): 72-75.
15. Tulner SA, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop, 2012, 36(9): 1923-1927.
16. 石展英, 趙良軍, 李百川, 等. 鎖定加壓鋼板外固定治療股骨遠端骨折術后感染. 中華實驗外科雜志, 2014, 31(7): 1601-1602.
17. Alemdar C, Azboy I, Ati? R, et al. Management of infectious fractures with " Non-Contact Plate” (NCP) method. Acta Orthop Belg, 2015, 81(3): 523-529.
18. Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1): 97-102.
19. 陸維舉, 李斌, 曾曉峰, 等. 清創后Ⅰ期植骨治療慢性骨髓炎的遠期療效. 中華創傷雜志, 2009, 25(12): 1090-1092.
20. Biz C, Iacobellis C. Nailing treatment in bone transport complications. Strategies Trauma Limb Reconstr, 2014, 9(2): 89-96.
21. Liodakis E, Kenawey M, Krettek C, et al. Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes. Int Orthop, 2011, 35(9): 1397-1402.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of femur re-fracture with occult infection by using non-contact locking plate under deep fascia

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