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

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2.	Busam ML, Esther RJ, Obremskey WT. Hardware removal: indications and expectations. J Am Acad Orthop Surg, 2006, 14(2): 113-120.
3.	储为民, 王宇知, 程向国. 股骨干骨折术后钢板周围再骨折原因分析及治疗体会. 临床骨科杂志, 2011, 14(3): 328, 331.
4.	陈长青, 丁真奇, 郭林新, 等. 钢板结合异体骨板治疗股骨干内固定术后再骨折. 中国骨伤, 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.	刘林涛, 马宝通, 叶伟胜. 股骨干骨折内固定术后隐性感染致骨不连. 中华骨科杂志, 2006, 26(2): 132-133.
8.	孔志刚, 于海泉. 骨折内固定术后隐性感染致骨折不愈合及愈合不良的临床分析. 中华创伤外科杂志, 2010, 12(3): 212-216.
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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.	章莹, 朱昌荣, 肖进, 等. 锁定加压钢板外置在胫骨感染性骨不连治疗中的应用. 中华创伤骨科杂志, 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, 赵良军, 李百川, 等. 锁定加压钢板外固定治疗股骨远端骨折术后感染. 中华实验外科杂志, 2014, 31(7): 1601-1602.
17.	Alemdar C, Azboy I, Atiç 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.	陆维举, 李斌, 曾晓峰, 等. 清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效. 中华创伤杂志, 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. 涂泽松, 李逸群, 吴峰. 股骨骨折钢板取出后再骨折的病理学观察. 中国骨伤, 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. 储为民, 王宇知, 程向国. 股骨干骨折术后钢板周围再骨折原因分析及治疗体会. 临床骨科杂志, 2011, 14(3): 328, 331.
4. 陈长青, 丁真奇, 郭林新, 等. 钢板结合异体骨板治疗股骨干内固定术后再骨折. 中国骨伤, 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. 刘林涛, 马宝通, 叶伟胜. 股骨干骨折内固定术后隐性感染致骨不连. 中华骨科杂志, 2006, 26(2): 132-133.
8. 孔志刚, 于海泉. 骨折内固定术后隐性感染致骨折不愈合及愈合不良的临床分析. 中华创伤外科杂志, 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. 章莹, 朱昌荣, 肖进, 等. 锁定加压钢板外置在胫骨感染性骨不连治疗中的应用. 中华创伤骨科杂志, 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, 赵良军, 李百川, 等. 锁定加压钢板外固定治疗股骨远端骨折术后感染. 中华实验外科杂志, 2014, 31(7): 1601-1602.
17. Alemdar C, Azboy I, Atiç 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. 陆维举, 李斌, 曾晓峰, 等. 清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效. 中华创伤杂志, 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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