A lifelong story: a case report of a successfully treated femoral shaft infected nonunion

Abstract

Introduction: Fracture healing is a very important clinical event for fracture-patients and for the doctors who treat them. Many factors can interfere with bone healing. The interference may cause delayed union or even nonunion. Nonunion management may cause financial and disability problems to the patient. Diamond concept taught us the importance of bone healing nature. In this case report, we will present the importance of diamond concept in the treatment of a nonunion case. Case Report: We present a 21-year-old obese-heavy smoker-male with chief complaint of pain on the left thigh since a year ago and was diagnosed with infected nonunion of the left femur. The patient had a history of moderate head injury and closed fracture of the left femur as the result of motor vehicle accident. He was treated in the first hospital by open reduction and internal fixation (ORIF) with plate and screw. Unfortunately, the pain still persisted and the implant was broken. Five months after the first surgery, he underwent another surgery in the second hospital and had an ORIF revision with plate and screw. Four months after the surgery, the wound was not healed, the pain still persisted and the implant was broken again. The patient came to our center, and we performed debridement, ORIF revision with longer plate, intraoperative deep specimen culture, decortication, and bone grafting. Empirical antibiotics by culture was given postoperatively and specified antibiotics was given by culture results. The wound healed, but the pain still persisted and in 8 months, the implant was broken once more. The patient underwent another surgery and had an ORIF revision with plate and screw and bone grafting in our center. In another seven months, finally, the left femur was joined. Results: Seven months after the last surgery, clinical and radiological union were achieved, and there was no sign of infection. The patient was quite happy with the result eventhough with a leg length discrepancy. He can do his daily activities with additional footwear.