25 year old male with type 3 b open fracture of distal femur and proximal tibia and lateral facet of patella presented I week after the injury with infected ( wound was contaminated with mud and leaves found 1 week after the injury when the patient presented to us).
Repeated debridement daily under epidural 5 times in 6 days followed primary grafting with iliac crest HAP granules soaked in polymyxcin which was sensitive for gram negative enterocooci and E. coli.
The free flaps for the wound failed twice and was finally closed with negative pressure suction and skin grafting
At 6 months with no evidence of infection and the fracture show tricortical bridging. He is mobilised with a single crutch. The range of movement is 0 to 60 degrees with quads tightness.
At 6 months with no evidence of infection and the fracture show tricortical bridging. He is mobilised with a single crutch. The range of movement is 0 to 60 degrees with quads tightness.
I believe the local delivery of antibiotics with HAP granules with slow leaching of antibiotics and osteoconduction helped as achieve union without infection by 6 months.
dear doctor,
ReplyDeleteplease include the proceedure video and photographs.
As far as the technique goes there are no tricks here execpt for MIPO. The differnce here is aggressive debridement, antibiotic soaked HAP for Infection and osteoconduction and bone grafts for osteoinduction.
ReplyDeleteNegative pressure using commerical equipment for wound closure is available with smoth and nephew as well Arjohuntleigh
dear doctor,
ReplyDeletewould like to more about the ngative pressure that is been used for the wound closure in this case.
WOUND ASSIST tnp IS THE VACCUM MACHINE USED AVAILABLE IN INDIA. wEBSITE.WWW.easytnp.com.
ReplyDeletesir,
ReplyDeleteWhat are the antibiotics that can be mixed with HAP..?Unlike PMMA, where we need to use heat stable antibiotics, are there any recommendations for use of antibiotic with HAP? One more concern is the sterility of the local HAP marketed by BASIC.?Have you used this company extensively.
sir, i think this is the most classical case for an ordinary orthopaedic surgeon like me, out of all the cases.
ReplyDelete