Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up
- 17 Downloads
Nonunion of femur fractures is a devastating disabling complication which is rare in children. The purpose of this study was to report the outcomes of treating infected femur nonunions in children by the Ilizarov fixator in one stage.
Patients and methods
The study included 13 patients with unilateral infected nonunion of the femur with an average age of 9.1 years. The nonunion duration averaged 10.69 months. Ten cases were draining nonunions, and three patients had quiescent sinuses. Associated problems include shortening in all cases (mean 3.5 cm), joint stiffness (9 cases), and angular deformity (7 cases). The quiescent cases were treated by bloodless monofocal compression-distraction. Four draining cases were treated by debridement and compression with relengthening through nonunion site. The remaining six cases were treated by bifocal technique.
The mean follow-up duration was 60.15 months. External fixation period averaged 5.3 months. Successful union was achieved in all patients. Recurrences of infection occurred in two cases including one with refracture and another one with late pathological fracture. Other complications included pin tract infections, one delayed union, two residual angular deformities, and 6 cm residual shortening in one patient. ASAMI bone results were excellent (8 patients), good (3 patients), fair (one patient), and poor (one patient). The functional results were excellent (9 cases), good (3cases), and fair (one case).
The Ilizarov method provided a viable treatment option for treating paediatric infected femur nonunions in single stage of management with infection control in most cases and satisfactory outcomes.
KeywordsNonunion Paediatric femur Infection External fixator Ilizarov
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective type of study formal consent is not required.
- 1.SawyerJR SDD (2017) Fractures and dislocations in children. In: Azar F, Canale ST, Beaty J (eds) Campbell’s operative orthopaedics, 13th edn. Elsevier/Mosby, Philadelphia, pp 1424–1569Google Scholar
- 11.Sales de Gauzy J, Fitoussi F, Jouve JL, Karger C, Badina A, Masquelet AC (2012) French Society of Orthopaedic Surgery and Traumatology (SoFCOT). Traumatic diaphyseal bone defects in children. Orthop Traumatol Surg Res 98:220–226. https://doi.org/10.1016/j.otsr.2012.01.001 CrossRefPubMedGoogle Scholar
- 13.Galle SE, Zamorano DP (2018) Tibial nonunions. In: Agarwal A (ed) Nonunions diagnosis, evaluation and management. Springer Science+Business Media LLC, New York, pp 287–308Google Scholar
- 14.Barral JP, Gil DR, Vergara SS (1991) Atlas for the insertion of transosseous wires. In: Bianchi-Maiocchi A, Aronson J (eds) Operative principles of Ilizarov; fracture treatment, non-union, osteomyelitis, lengthening, deformity correction. Williams and Wilkins, Baltimore, pp 463–549Google Scholar
- 26.Hissnauer TN, Stiel N, Babin K, Rupprecht M, Ridderbusch K, Rueger JM, Stuecker R, Spiro AS (2017) Recombinant human bone morphogenetic protein-2 (rhBMP-2) for the treatment of nonunion of the femur in children and adolescents: a retrospective analysis. Biomed Res Int 2017:3046842. https://doi.org/10.1155/2017/3046842 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Soldado F, Fontecha CG, Barber I, Velez R, Llusa M, Collado D, Rodriguez-Baeza A, Martinez-Ibañez V (2012) Vascularized fibular periosteal graft: a new technique to enhance bone union in children. J Pediatr Orthop 32(3):308–313. https://doi.org/10.1097/BPO.0b013e31824b2843 CrossRefPubMedGoogle Scholar
- 28.Patwardhan S, Shyam AK, Mody RA, Sancheti PK, Mehta R, Agrawat H (2013) Reconstruction of bone defects after osteomyelitis with nonvascularized fibular graft: a retrospective study in twenty-six children. J bone joint Surg am 95(9):e56, S1. https://doi.org/10.2106/JBJS.K.01338 CrossRefGoogle Scholar