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Abstract
The postoperative complications in open reduction and internal fination of supracondylar and intercondylar fractures of the femur include leg length discrepanfy, infection, skin necrosis, irritation by implants, valgus or varus deformity, bony destruction associated with vascular disturbance, instability of thr knee joint and translation of the frartured surface. The most vulnerable complication among them may be infection. Then infected nonunion is dangerous to the patients and its treatment is very difficult.
Authors evaluated 25 cases of 25 patients who were treated and followed up evaluation over one year in the department of Orthopaedic Surgery, College of Medicine, Hallym University from January, 1988 to June, 1995. All cases were treated by open reduction & internal fixations. Four cases of them had developed infected nonunion. After we treated these cases wr could reach following results:
1. The cause of infection was primarily staphylococcus aureus in all cases.
2. Among 4 cases of infected nonunion, external fixator was preformed in 3 patients and interlocking IM nailing in remainder.
3. The infection was managed with intravenous antibiotics, frequent irrigation. insertion of antibiotic impregnated beads and daily dressing.
4. Erythrocyte sedimentation rate was normalized at average 8.5 months(range, from 1.5 to 26 months).
5. The union was accomplished at mean 5.4 months in 21 cases without infection and at mean 17.7 months(range, from 10 to 35 months) in 4 cases with infued nonuion after infection developed.
6. The main complications were limitated range of motion of the knee(30 to 100 degree flexion) and shortening of affected extremity.
7. In conclusion, we suggest that early removal of implant in situ, external fination and bone graft after infection controlled is an adequate plan for the treatment of infected nonunion in supracondylar and intracondylar fractures of the femur.
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