Abstract
A 54-year-old woman sustained an open fracture of the right femoral shaft after a bicycle accident in 1985. Several operations were performed, the last including internal fixation using a plate and screws. In 2002, acute diverticulitis was treated with ciprofloxacin/metronidazole. In 2007, she presented with pain and swelling of the right thigh. Plain radiographs showed radiolucent femoral areas (Figure (Figure1a1a and b). Treatment was with debridement and removal of orthopedic hardware except for a difficult-to-remove screw fragment. Gentamicin beads were temporarily placed along the femur. Eight intraoperative specimens showed no growth after 10 days. Because of poor wound healing, a computed tomography scan was obtained, showing a sinus tract, femoral cortical defects, and intramedullary air (Figure (Figure1c–e).1c–e). Additional debridement was done; cultures of intraoperative biopsy specimens again remained sterile. Amoxicillin/clavulanate was prescribed for 2 weeks, and ciprofloxacin/rifampin was prescribed for 10 weeks.
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