Abstract

• PURPOSE: The purpose of this study was to find out the treatment efficiency of two stage osteosynthesis with antibiotic cement beads and external skeletal fixation for infected nonunion of femur. MATERIALS AND METHODS: In the first stage, radical debridement was performed. The soft tissue and bony defects were filled with antibiotics impregnated cement beads and the nonunion site was stabilized with external skeletal fixation. In the second stage, the debrided nonunion site was repaired with bone grafting. The intervening time between the first and second stages of treatment was 4 to 6 weeks (average 5.4 weeks). The bone defects ranged from 0.5 to 14cm, Autogeneous iliac cancellous bone grafting was performed in 17 patients and microvascularized fibular graft was performed in 5 patients. RESULTS: The follow-up period was average 45 months (range, 27-62 months). Infection control and bone union were achieved in all 22 cases. Postoperative infection after the second-staged bone grafting occurred in one patient. This recurred case was treated with repeated two staged operation. Even though aggressive physical theraphy was done, all patients had relevant knee flexion deficits. 14 patients were achieved more than 100 degrees of knee flexion, but 8 patients had less than 80 degrees of range of motion. CONCLUSION: We have found that two-stage treatment with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting is an acceptable treatment modality for the management of infected femoral nonunion. It results in rapid recovery from osteomyelitis and a predictable recovery from nonunion.
• Key words: Femur, Infected nonunion, Antibiotic cement beads, External fixation, Two-stage treatment

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