Chalak Ajit, Kale Sachin Yashwant, Mehra Shivam, Gunjotikar Aditya, Singh Sushmit, Sawant Raj
Department of Orthopaedics, Padmashree Dr. D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India.
J Orthop Case Rep. 2023 Aug;13(8):132-136. doi: 10.13107/jocr.2023.v13.i08.3846.
Femoral fractures in adults are around 3-6% and 0.4% of all the fractures are usually distal femoral fractures, frequently consisting of high-energy injuries which are associated with compound trauma. Conventionally, femoral-tibial fusion remains one of the last treatment choices for the recurrent septic failure.
We report a unique case where a 52-year-old male had presented with a post-operative infected non-union of distal femur and patella with discharging sinus and distal femur plate in situ. The patient presented to our outpatient department with complaints of pain and swelling over right knee with discharging sinus with fixed flexion deformity of 20° for 1-year post trauma and post-surgery. The discharging sinus was over lateral aspect of knee with purulent discharge. His blood parameters were suggestive of high erythrocyte sedimentation rate, and C-reactive protein levels and a Gram staining were suggestive of Gram-negative bacilli. X-ray showed non-union of distal femur and osteomyelitic changes and knee subluxation with distal femur plate and encirclage with K-wire for patella in situ. The patient underwents three-stage procedure of debridement with implant removal, followed by knee arthrodesis and ultimately limb lengthening surgery.
Our case report is unique and distinctive as it shows that, when a case of infected non-union of distal femur comes with stiff and non-salvageable knee with severe arthritic changes and financial constraints, we should consider for knee arthrodesis with ilizarov ring fixator and limb lengthening surgery. Although it yielded stiff knee but with functioning limb without limb length discrepancy.
成人股骨骨折约占所有骨折的3% - 6%，其中约0.4%为股骨远端骨折，常由高能损伤所致，且多伴有复合创伤。传统上，股胫融合术仍是复发性感染性骨不连的最终治疗选择之一。
我们报告了一例独特病例，一名52岁男性，术后出现股骨远端和髌骨感染性骨不连，伴有窦道形成，股骨远端钢板在位。患者因右膝疼痛、肿胀伴窦道形成前来我院门诊就诊，创伤及手术后1年，右膝固定屈曲畸形20°。窦道位于膝关节外侧，有脓性分泌物。其血液检查参数提示红细胞沉降率和C反应蛋白水平升高，革兰氏染色提示革兰氏阴性杆菌。X线显示股骨远端骨不连、骨髓炎改变以及膝关节半脱位，股骨远端钢板在位，髌骨用克氏针环扎固定。患者接受了分三个阶段的手术，包括取出植入物的清创术，随后进行膝关节融合术，最终进行肢体延长手术。
我们的病例报告独特且与众不同，因为它表明，当股骨远端感染性骨不连合并僵硬且无法挽救的膝关节、严重关节炎改变以及经济受限的情况时，我们应考虑采用伊里扎洛夫环形固定器进行膝关节融合术和肢体延长手术。虽然术后膝关节僵硬，但肢体功能良好，无肢体长度差异。
