Concluded Case

ex fix fixation

45 male with profuse discharging puss and abcesses over the distal thigh with painful abnormal mobility present done else where 1 and half year back Now planning implant removal and ex fix Any other opinion

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Concluded answer

Debridement with ex fix

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This is chronic osteomyelitis of distal femur. You need 2 stage masquelet procedure of this. First stage through debridement +implant removal+culture sensitivity post debridement +Antibiotic cement spacer +external fixator or a long distal femur locking plate for stability. IV antibiotics for 6 weeks based on culture sensitivity. Repeat esr crp after 6 weeks. Second stage once infection markers are normal.Membrane would be found.Elevate it +remove the spacer +bone graft(fibula strut for stability +iliac crest for biology)+suture the membrane+continue with distal femur locking plate or plate it if you had applied externak fixator in first stage. Just implant removal and external fixator would not do justice.

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Old fracture if comminated supra condylar fracture demure treated with internal fixation with L plate with screw fixation but unfortunately screws gave way with disruption of position of fractured fragment may be due to muscle pull. External fixator to maintain the position

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Union process does not seem to have thoroughly completed. Dedication if all the parameters if pt permit.

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Osteomyelitis removal of plate & screw drilling scouping Culture sensitivity External fixator

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Malunion of the fracture femur ,in my opinion refixation advised

Re fixation with active infection ?
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Debridement with ex fix

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