Conditions affecting treatment of pertrochanteric osteomyelitis

Although osteomyelitis following treatment of pertrochanteric fractures is rare, management can be difficult and often results in several physical and economic difficulties. Data regarding treatment of patients with pertrochanteric osteomyelitis is currently limited. This retrospective study evaluates the management of pertrochanteric osteomyelitis and presents our experience using a two-stage treatment protocol.

From 1984 to 1998, twenty-three pertrochanteric osteomyelitis cases were treated with a two-stage protocol comprising of an external skeletal fixator or Buck traction after radical debridement in the first stage and reconstruction in the second stage. The study included sixteen males and seven females with a mean age of 48.3 years (range 16-82 years). Patients were categorized as "successful" or "difficult" according to the number of operations they had undergone. Conditions including patient age, compromised host, interval before treatment, fracture severity, nonunion, hip joint involvement, multiple organisms and the presence of oxacillin-resistant Staphylococcus aureus were recorded for analysis.

Only twelve of the twenty-three (52%) cases were successfully managed and infection recurred in four (17.4%) cases at final follow-up. Difficult cases managed by the two-stage protocol were more likely to be characterized by younger age (p = 0.03), unstable fractures (p = 0.003) and nonunions (p = 0.027).

The use of external skeletal fixation is not recommended for managing pertrochanteric osteomyelitis. Success using a two-stage protocol was difficult to achieve. Initial fracture severity should be carefully assessed when devising a treatment protocol for pertrochanteric osteomyelitis.