Intercalary diaphyseal endoprosthetic reconstruction for tibial septic non-union in an elderly patient: A case report

• Published in: Orthopaedics & traumatology, surgery & research Vol. 103; no. 8; pp. 1217 - 1220
• Main Authors: Herry, Y., Reynaud, O., Ferry, T., Servien, E., Neyret, P., Lustig, S.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.12.2017
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Bone Cements; Diaphyses - injuries; Diaphyses - surgery; Drug Delivery Systems; Female; Fractures, Ununited - etiology; Fractures, Ununited - surgery; Humans; Intercalary prosthesis; Limb Salvage - instrumentation; Prostheses and Implants; Sepsis - complications; Sepsis - microbiology; Septic non-union; Tibia - surgery; Tibial Fractures - surgery; Intercalary prosthesis; Septic non-union
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2017.09.011

The surgical treatment of septic non-union is challenging and carries a high failure rate. Bone defect management and fracture site stabilisation are key treatment objectives. We report the case of a 75-year-old woman who underwent intercalary endoprosthetic reconstruction of a large tibial defect due to septic non-union after two previous treatment failures. The two-stage procedure involved extensive excision of infected tissues and implantation of an antibiotic-loaded cement spacer followed by insertion of an intercalary endoprosthesis. Within only 2 months after the procedure, the patient was able to walk with no assistive device and no limp. After 12 months and 6 months after antibiotic discontinuation, the laboratory tests and imaging studies showed no evidence of infection. Intercalary endoprosthetic reconstruction may be a valid treatment option to avoid amputation for recurrent septic non-union, particularly in elderly patients.