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Case example
A case of infected tibial nonunion was successfully resolved.
Patient of Dr. Margarida Vicente at HFF.
Open tibial fracture, infected osteosynthesis with fistulas, surgical revision with an external fixator.
Surgical protocol:
– Removal of the fixator and curettage of the pins and fistulous tracts.
– Multiple perforations at the nonunion site.
– Reaming of the medullary canal to 10 mm.
– Irrigation using a nasogastric tube and suction.
– Reaming to 14 mm and preservation of the fragment.
– Preparation of the nail with PMMA impregnated with 2 g of flucloxacillin and 2 g of vancomycin.
– Placement of the nail with distal locking and compression of the nonunion site.
– No proximal locking of the nail in order to preserve its mobility.
– Placement of a rhizomelic graft using a cannula at the level of the nonunion.
After 3 months, the infection had healed and the nonunion had consolidated.
