| 摘要 |
Objective: The management of infection following intramedullary (IM) nailing of a femoral shaft fracture remains a challenge to orthopedic surgeons. The purpose of this study is to analyze the clinical results of the treatment of infection after IM nailing.
Methods: The records of twenty-one patients who developed infections following IM nailing of the femoral shaft at the authors’ hospital between 1993 and 1997 were collected and analyzed retropectively. Acute infection occurred in 11 patients, subacute infection in 5, and chronic infection in 5. The nails were retained in 12 patients. Nine nails were removed at the time of debridement and the fractures were stabilized with an external fixation apparatus.
Results: In nail-retaining group, all fractures healed within an average period of 9 months (range, 5 to 15 months) after surgical debridement. There was no recurrence of infection at an averaged follow-up of 25 months (range, 12-76 months). In the nail-removal group, seven fractures healed within an average period of 10 months (range, 4-24 months) after treatment. At an average follow-up of 33.8 months (range, 12-79 months), infected nonunion was noted in 2 patients. More complications occurred in the nail-removal patients in comparison with the nailretaining patients. Range of motion of the knee joint was usually limited if a fracture was stabilized with an external fixation for a prolonged period of time.
Conclusions: Retaining of the intramedullary nail is preferable if the fixation is stable and the infection is under control. The external fixation is most suitable for uncontrollable osteomyelitis or infected nonunion. Staged bone graft is usually necessary to enhance fracture healing. |
