Case discussion Case 7 AOTrauma Masters CourseSDL Infection

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Case discussion Case 7 AOTrauma Masters Course—SDL Infection course

Case discussion Case 7 AOTrauma Masters Course—SDL Infection course

Case description • 40 -year-old MCA • Open tibial fracture 2

Case description • 40 -year-old MCA • Open tibial fracture 2

Case description • 40 -year-old MCA • Open tibial fracture • Irrigation and drainage

Case description • 40 -year-old MCA • Open tibial fracture • Irrigation and drainage • Intramedullary nail 3

Case description • Four months nonhealing • Wound drainage from open fracture site •

Case description • Four months nonhealing • Wound drainage from open fracture site • Increasing pain 4

Options—ARS Locally debride and. . . 1. Remove nail, ream canal and renail 2.

Options—ARS Locally debride and. . . 1. Remove nail, ream canal and renail 2. Remove nail, ream canal, antibiotic nail 3. Remove nail, ream canal, external fixation 4. Remove nail, segmental resection, transport 5

Cultures • Pseudomonas aeruginosa • Streptococcus oralis • Staphylococcus auricularis • Peptostreptococcus magnus 6

Cultures • Pseudomonas aeruginosa • Streptococcus oralis • Staphylococcus auricularis • Peptostreptococcus magnus 6

• Taken to operating room • Debrided • Antibiotic nail 7

• Taken to operating room • Debrided • Antibiotic nail 7

• Taken to operating room • Debrided • Antibiotic nail • One month

• Taken to operating room • Debrided • Antibiotic nail • One month • Healing? 8

• Taken to operating room • Debrided • Antibiotic nail • 2 months

• Taken to operating room • Debrided • Antibiotic nail • 2 months • Some healing 9

• Taken to operating room • Exchanged nail • After negative cultures 10

• Taken to operating room • Exchanged nail • After negative cultures 10

3 years later • Increasing pain • Erythrocyte sedimentation rate: 104 • C-reactive protein:

3 years later • Increasing pain • Erythrocyte sedimentation rate: 104 • C-reactive protein: 64 • Drainage 11

• Fracture healed • Taken to operating room • Hardware removal • Placement

• Fracture healed • Taken to operating room • Hardware removal • Placement of antibiotic beads 12

2 years after last debridement • Healed • Beads resorbed 13

2 years after last debridement • Healed • Beads resorbed 13

After 10 years No complaints 14

After 10 years No complaints 14

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