Interesting cases

Dr Manish Gupta
Consultant orthopedics
• 37 years male

• Presentation
• C/O Pain and swelling left thigh since 4-6 weeks
• No h/o Injury or fever

• Radiology
• Xray and MRI thigh
• Surgery
• Debridement and saucerization through cortical window
• Stimulan beads mixed with teicoplanin and vancomycin placed at the site of
infection inside medullary cavity and in adjacent soft tissue
• Pus drained was send for culture sensitivity

• Advised to avoid weight bearing on operated leg

• Patient being non compliant….

• Fracture shaft femur

• Treatment options…
• Infection
• Temporary external fixator
• Pain relief
• Stability at fracture site
• Infection control
• 6 weeks post fixator application,
definitive surgery done as..
• 1 month follow up
• Fracture healing well
• No sign of infection
• 2 month follow up
• Fracture healing well

• Further plan ..
• 73 years male
• Presentation
• H/O Operated else for IT femur fracture 6 weeks back, developed secondary
infection at surgical site
• On presentation had discharging sinus with active purulent discharge

• Xray ..
• Plan
• Fracture healing ?
• Remove source of infection
• Bug isolated was gram negative
cocci
• Surgery
• Implant removed
• Debridement
• Stimulan grafting
• 1 month follow up
• Infection controlled
• No active pus discharge
• Started weight bearing
• 2 months post op
• No infection
• Further plan …
• 32 years male
• Presentation
• H/O RTA with injury to right thigh
• Sustained grade 3 compound intra-articular fracture distal femur wth
• bone loss apprx. 7-8 cm

• Xray
• Surgery
• Debridement +
• Plating for fracture femur
• Fracture gap filled with
bone cement
(MASQUELET TECHNIQUE)
• MASQUELET TECHNIQUE

• Debridement
Stage • Cement spacer insertion
1

• Open membrane and remove spacer

Stage
2 (6-
• Bone grafting
8 • Close membrane
week
s)

• Follow with x-ray

Stage • Bone healing 4-5 months
3
• At 6 weeks post op
• No sign of infection
• Second surgery
• Removal of bone cement and
• Bone grafting
The patient was taken
for second surgery six
weeks after the
primary surgery to
remove the antibiotic
cement spacer and
bone grafting
This is the quantity of
antibiotic cement which
was removed in piecemeal
This picture shows the
bone gap from where
the cement spacer is
removed
This C-arm image is showing
the bone gap after removal of
antibiotic cement spacer
Corticocancellous and cancellous bone
grafts taken from bilateral posterior iliac
crest and the masqulet membrane was
filled with corticocancellous graft. Now
we hope a good osteogenesis in the bone
gap within a period of 3-4 months to
allow the patient for full weight bearing
and routine activities.