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Use of cemented spacer with a handmade stem to treat acute periprosthetic tibial fracture infection: a case report.

Font-Vizcarra L, Izquierdo O, García-Nuño L, González A, Diaz-Brito V, Castellanos J - Open Orthop J (2014)

Bottom Line: All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted.After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace.There were no radiological or clinical signs of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Trauma Surgery of Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.

ABSTRACT
We report an 85-year-old woman with dementia and dependent for normal life activities who was admitted due to a left periprosthetic tibial fracture. The tibial component was replaced by one with a long stem and she was discharged. Four weeks after the intervention the patient was re-admitted due to an acute prosthetic joint infection. All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient, it was decided to keep the spacer as a definitive treatment. After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace. There were no radiological or clinical signs of infection.

No MeSH data available.


Related in: MedlinePlus

AP and lateral X-rays at 24 months follow-up.
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Figure 4: AP and lateral X-rays at 24 months follow-up.

Mentions: technique: first, the cement was injected using a cement gun into a mold (although we used the tube used for cementing the femoral component of hip prosthesis, other molds, such as chest tubes, could be used) [3]. After this, a Kischner wire was inserted into the tube and buried in the cement leaving about an inch uncovered to allow for connecting it with the tibial plateau cement spacer. The limb was immobilized with knee extension with an orthosis for 4 weeks to control rotational forces at the level of the fracture focus. The wound evolution was correct except for a skin defect at the level of tibial tuberosity that required a neurocutaneous pedicled graft. Based on antibiogram, specific-parenteral antibiotherapy (imipenem 28 days + vancomycin 17 days followed by 11 days of linezolid) was prescribed. The patient was discharged with an articulated knee brace. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient and short life expectancy, it was decided to keep the spacer as definitive treatment. In the latest follow-up (24 months after surgery), the patient was able to sit without pain and to stand with help using a knee brace. There were no radiological (Fig. 4), clinical (Fig. 5), or blood analysis signs of infection.


Use of cemented spacer with a handmade stem to treat acute periprosthetic tibial fracture infection: a case report.

Font-Vizcarra L, Izquierdo O, García-Nuño L, González A, Diaz-Brito V, Castellanos J - Open Orthop J (2014)

AP and lateral X-rays at 24 months follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927377&req=5

Figure 4: AP and lateral X-rays at 24 months follow-up.
Mentions: technique: first, the cement was injected using a cement gun into a mold (although we used the tube used for cementing the femoral component of hip prosthesis, other molds, such as chest tubes, could be used) [3]. After this, a Kischner wire was inserted into the tube and buried in the cement leaving about an inch uncovered to allow for connecting it with the tibial plateau cement spacer. The limb was immobilized with knee extension with an orthosis for 4 weeks to control rotational forces at the level of the fracture focus. The wound evolution was correct except for a skin defect at the level of tibial tuberosity that required a neurocutaneous pedicled graft. Based on antibiogram, specific-parenteral antibiotherapy (imipenem 28 days + vancomycin 17 days followed by 11 days of linezolid) was prescribed. The patient was discharged with an articulated knee brace. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient and short life expectancy, it was decided to keep the spacer as definitive treatment. In the latest follow-up (24 months after surgery), the patient was able to sit without pain and to stand with help using a knee brace. There were no radiological (Fig. 4), clinical (Fig. 5), or blood analysis signs of infection.

Bottom Line: All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted.After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace.There were no radiological or clinical signs of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Trauma Surgery of Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.

ABSTRACT
We report an 85-year-old woman with dementia and dependent for normal life activities who was admitted due to a left periprosthetic tibial fracture. The tibial component was replaced by one with a long stem and she was discharged. Four weeks after the intervention the patient was re-admitted due to an acute prosthetic joint infection. All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient, it was decided to keep the spacer as a definitive treatment. After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace. There were no radiological or clinical signs of infection.

No MeSH data available.


Related in: MedlinePlus