[Post-traumatic infection of the femur]

Thirty-two cases of post-traumatic infection of the femur are reported. Apart from antibiotic treatment, surgical treatment comprised two components: excision and stabilization followed by a second stage of reconstruction by bone grafting. The excision was as extensive as was necessary, including thirteen resections of the shaft and twelve sequestrectomies. Stabilization was preferably achieved by an ALJ external fixator applied in a single posterolateral plane leaving the quadriceps free. Two types of reconstruction were used: 24 open cancellous grafts by the Burri-Papineau method and 7 closed corticocancellous grafts. One patient was not grafted. In 5 cases of bone infection with fragility, 4 open cancellous grafts gave sound bone and a healed wound in a mean of 6 months. In 16 out of 20 septic nonunions treated by open cancellous grafts, union and wound healing was obtained in a relatively short time, a mean of 8.2 months. But in four other cases, it was a matter of saving limbs with arterial damage, major lesions of the soft tissues and involvement of the knee joint. In these the healing time was much longer. The seven closed corticocancellous grafts had less satisfactory results; three of them required multiple procedures and healing was delayed for a mean of 27 months. Amputation was needed in one case. The authors consider that closed corticocancellous grafts are only suitable for the simplest cases in which, after excision and stabilization, good bone contact remains. But when the excision requires a considerable removal of bone involving its whole circumference, open cancellous grafts are preferable and lend themselves better to secondary bony procedures. In addition, they seem to be less subject to refracture because of the histological process of bone reformation.