Failure osteosynthesis in a open diaphyseal femoral fracture (case study)

Abstract

The aim: presentation of a treatment strategy in a clinical case of open femoral fracture with septic manifestations. Materials and methods: Patient, male of 21 years old, in august 2014 as a result of an accident (motorcycle), he suffered an open diaphyseal fracture of the right femur (Gustillo-Andersen type II). Within 24 hours the patient was operated in a district hospital: surgical debridement and plate osteosynthesis. In postoperative period appeared clinical signs of septic process that was confirmed by laboratory tests. After a month he was transferred to our clinic. On clinical and radiological examination was revealed instability of osteosynthesis, micromicromobility at the fracture site and compresive hematoma on the right femur. We performed repeated debridement and bridge-plate osteosynthesis. In postoperative period the wound healed primary and inflammatory signs disappeared. The patient walked with crutches without loading operated leg during 3 months. At repeated control there was no radiological signs of consolidation. A bone plasty was proposed to patient, that he refused and followed dosed loading on the operated leg. At 5 months he presented with misalignment of bone fragments. Finally patient underwent repeated autoosteoplastic osteosynthesis with angular stability plate. Postoperative evolution was normal, patient initiated partial support after 2,5 months and total to 5 months. Results: At 6 months after the last intervention clinical and radiological evolution was favorable. The pain disappeared at total weight bearing, the volume of mobility of knee at the same side are complete. There are signs of bone consolidation. Conclusions: Although the final outcome of treatment is considered as good, the method of osteosinthesis remains questionable.