Letter to the Editor: Comment on Hosny GA, Ahmed AA. Paediatric infected femoral nonunion; mid-term results of a rare pr
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LETTER TO THE EDITOR
Letter to the Editor: Comment on Hosny GA, Ahmed AA. Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up. Reconstruction of pediatric infected femoral nonunion: single stage techniques Anil Agarwal 1 & Prateek Rastogi 1 & Rahul Yogendra Raj 1 Received: 15 March 2020 / Accepted: 26 March 2020 # SICOT aisbl 2020
Reconstruction of pediatric infected femoral nonunion: Single stage techniques We read with interest the article by Hosny and Ahmed on the subject [1]. The authors have brought out the nuances of management of paediatric infected femoral nonunion in an inclusive manner. The follow up of the presented series (average 60.15 months) is commendable. Paediatric infected femoral nonunion, although rare, is not uncommon for any facility dealing with a predominantly children’s population. The problem is seen more frequently in low socioeconomic countries where post osteomyelitic pathology is a major burden. Single stage treatment offer advantages of relatively shorter treatment span and fewer hospital visits. Illizarov methodology, as authors have shown, is successful but again is a specialized procedure requiring significant technical expertise and implant inventory. The fixator in younger child may have to be limited to a two ring construct due to limitation of limb size and available bone stock [1]. There is as well a post fixator consolidation time elongating the overall treatment period.
* Anil Agarwal
Prateek Rastogi [email protected] Rahul Yogendra Raj [email protected] 1
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India
We have described an alternative single stage technique for treating infected femoral nonunions in children [2]. Our surgical protocol involved an aggressive debridement, mechanical stabilization using an external fixator and application of copious autogenous nonvascularized bone graft spanning several centimeters above and below the nonunion. The post surgical period was covered by high dose broad spectrum antibiotics for six weeks. The average time for union in our series of 11 patients was 3.6 months (range, 2–6 months). Deep infection persisted despite osseous union in three patients. No patient required regrafting or additional surgical procedures. According to Paley’s criteria, there were three excellent, four good, two fair and two poor results. The major disadvantage of the procedure was limb shortening [>2.5 cm in 8/11 (72.7%)]. The method utilized common implants and procedure was feasible even in less equipped centres. Single stage procedures are usually condemned for higher reinfection rates (in some series upto 57%) [3, 4]. These claims have not been substantiated in modern day series [1, 2, 5]. The rate of infection control may be a slight inferior (~85–90%) to two staged procedures or those using local antibiotic beads [Patwardan et al. 96%, Zalarvas et al. 100%, Canavese et al. 100%] but that
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