V. Goni, P. Sudesh (Chandigarh, India)
Introduction: Management of pathological diaphyseal fractures in long bones secondary to osteomyelitis in children still remains a nightmare for the treating orthopaedic surgeon due to the varied course and uncertain results. This study highlights the role of rail fixator in the management of pathological femur fracture secondary to osteomyelitis in children.
Methodology: A total of four children [8-12 years age group] with pathological femur fractures operated between January 2012 and December 2012 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 paediatric mono-rail fixator. All patients received post-op antibiotics, based on intra-op culture and sensitivity reports, for six weeks [intravenously for the initial three weeks, orally for the remaining three weeks]. Weight bearing and knee range of motion were started in the early post operative period as soon as the children were pain free.
Results: Out of four cases, three fractures united but for one. Aseptic pin tract loosening was seen in one case. Limb length discrepancy was observed in all the cases.
Conclusion: Compression fixation achieved by mono-rail fixator is a viable option for the management of paediatric femur fractures secondary to active bony infection. It has the advantage of not only aiding in early weight bearing but also in establishing successful joint mobilization.