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VOLUME 51 , ISSUE 1 ( January-March, 2017 ) > List of Articles

RESEARCH ARTICLE

Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children

Balaji Saibaba, Prateek Behera, Siva S Santhanam

Citation Information : Saibaba B, Behera P, Santhanam SS. Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children. J Postgrad Med Edu Res 2017; 51 (1):17-21.

DOI: 10.5005/JPMER-51-1-17

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Introduction

Management of pathological diaphyseal fractures secondary to osteomyelitis in children still remains a nightmare for the treating orthopedic surgeon owing to the highly unpredictable clinical course and lack of certainty in achieving successful results. This study highlights the potential role of rail fixator in the management of pathological femur fracture secondary to osteomyelitis in children.

Materials and methods

A total of five children (8—13 years age group) with pathological diaphyseal fractures of femur (four cases) and tibia (one case), operated between January 2014 and December 2014, were included in the study. Chronic osteomyelitis was the underlying etiology in all the cases. The surgical management consisted of thorough debridement, lavage, freshening of fractured bone ends, opening of the bone ends, reduction and external stabilization using pediatric monorail fixator. All patients received postoperative antibiotics, based on intraoperative culture and sensitivity reports, for 6 weeks (intravenously for the initial 3 weeks, orally for the remaining 3 weeks). Weight bearing and knee range of motion were started in the early postoperative period as soon as the children were pain free.

Results

Staphylococcus aureus was the causative organism in all the cases. Out of five cases, four fractures united: Three femurs (between 9 and 12 weeks) and one tibia (11 weeks). There was one case of delayed union of femur (18 weeks). Septic pin tract loosening was seen in one case (femur) requiring prolonged antibiotic usage. Minimal limb length discrepancy (1—1.5 cm) was observed in all the cases.

Conclusion

Compression fixation achieved by monorail fixator can be considered as a viable option for the management of pediatric diaphyseal fractures secondary to active bony infection. It has the advantage of promoting bony union, aiding in early weight bearing, establishing successful joint mobilization, providing an option for future restoration of limb length, and improved patient comfort.

How to cite this article

Saibaba B, Gopinathan NR, Dhillon MS, Behera P, Santhanam SS. Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children. J Postgrad Med Edu Res 2017;51(1):17-21.


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  1. Pathologic fractures in children with acute Staphylococcus aureus osteomyelitis. J Bone Joint Surg Am 2012 Jan;94(1):34-42.
  2. Femoral shaft fractures in children treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires: a long-term follow-up results. Injury 1999 Mar;30(2):121-128.
  3. Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis. J Bone Joint Surg Am 1989 Dec;71(10):1448-1468.
  4. The use of Ilizarov frames in the treatment of pathological fracture of the femur secondary to osteomyelitis: a review of three cases. Injury 2007 Feb;38(2):240-244.
  5. Outcome of rail fixator system in reconstructing bone gap. Indian J Orthop 2014 Nov;48(6):612-616.
  6. Femoral lengthening with a rail external fixator: tips and tricks. Strategies Trauma Limb Reconstr 2010 Dec;5(3):137-144.
  7. Fracture treatment in children—data analysis and follow-up results of a prospective study. Injury 2001 Dec;32(Suppl 4):SD26-SD29.
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