Kalantar Seyyed Hadi, Bagheri Nima, Beheshti Fard Shahabaldin, Afzal Sina
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2023 Oct 24;112:108979. doi: 10.1016/j.ijscr.2023.108979.
Concurrent ipsilateral femoral malunion and nonunion present substantial clinical challenges requiring comprehensive surgical interventions. We describe a unique case of a 65-year-old male with these complications who was treated with a proximal femoral osteotomy, radical sequestrectomy, and free fibula graft.
The patient underwent over 10 years of multiple surgical interventions, including hardware removal, local debridement, antibiotic-loaded cement spacer placement, autologous bone grafting, and external fixator applications, yet infectious non-union persisted. Additionally, a periprosthetic subtrochanteric fracture led to malunion due to his lack of consent for surgery. Despite attempted distraction osteogenesis, limited patient cooperation hindered success. Subsequent Free fibula grafting ultimately achieved satisfactory union, enabling full weight-bearing and according to the Short Form-36 (SF-36), the patient's physical function score increased from 30 % to 65 %.
In the field of orthopedic surgery, addressing infectious non-union in long bones presents a notable clinical challenge. Radical debridement is fundamental to its management, a procedure that, in severe and resistant cases, may give rise to critical-sized bone defects. To address these defects, a spectrum of biological reconstruction techniques has evolved over time. The selection of the most appropriate strategy necessitates individualization based on the patient and the specific nonunion characteristics.
This case underscores the importance of radical debridement for infectious non-union. It emphasizes the consideration of biological reconstruction for critical-sized defects, particularly when concurrent deformities are present. Patient compliance is pivotal for treatment success, necessitating alternative approaches when cooperation is compromised.
同侧股骨畸形愈合与骨不连同时存在带来了巨大的临床挑战，需要全面的手术干预。我们描述了一例65岁男性患有这些并发症的独特病例，该患者接受了股骨近端截骨术、彻底的死骨切除术和游离腓骨移植术。
该患者在超过10年的时间里接受了多次手术干预，包括取出内固定物、局部清创、放置含抗生素的骨水泥间隔物、自体骨移植和应用外固定架，但感染性骨不连仍然存在。此外，由于患者不同意手术，假体周围转子下骨折导致了畸形愈合。尽管尝试了牵张成骨，但患者配合有限阻碍了成功。随后的游离腓骨移植最终实现了满意的愈合，使患者能够完全负重，根据简明健康状况调查量表（SF - 36），患者的身体功能评分从30%提高到了65%。
在骨科手术领域，处理长骨感染性骨不连是一项显著的临床挑战。彻底清创是其治疗的基础，在严重和难治性病例中，该手术可能会导致临界尺寸的骨缺损。为了应对这些缺损，随着时间的推移，一系列生物重建技术不断发展。选择最合适的策略需要根据患者和特定骨不连的特征进行个体化。
本病例强调了彻底清创治疗感染性骨不连的重要性。它强调了对于临界尺寸缺损，尤其是存在并发畸形时，考虑生物重建的必要性。患者的依从性对于治疗成功至关重要，当患者配合度不佳时需要采取替代方法。
