Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report

M.P Menezes,R.C Costa,M.E.B.A.M Conceição,B.W Minto,L.G.G.G Dias

doi:10.1590/1678-4162-11156

Abstract

ABSTRACT Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.

Highlights

INTRODUCTIONChronic osteomyelitis culminates in intermittent or persistent lameness, cutaneous fistulas, local pain and swelling, hyperesthesia, pyrexia and anorexia in addition to extensive bone resorption with consequent replacement by fibrous tissue and bone sequestration impairing osteogenic activity and contributing to biologically inactive nonunion development due to the small local vascularization (Sturion et al, 2000)
The patient was diagnosed with a femoral septic nonunion
Antimicrobial therapy was discontinued three days before the surgical re-intervention, and a new bacterial culture and antimicrobial susceptibility testing performed on the removed implants confirmed the absence of infectious agents

Summary

INTRODUCTION

Chronic osteomyelitis culminates in intermittent or persistent lameness, cutaneous fistulas, local pain and swelling, hyperesthesia, pyrexia and anorexia in addition to extensive bone resorption with consequent replacement by fibrous tissue and bone sequestration impairing osteogenic activity and contributing to biologically inactive nonunion development due to the small local vascularization (Sturion et al, 2000). Material, and surgical field, laparotomy was performed through the right flank, caudal to the 13th rib, to generate a flap of the greater omentum, which was guided to the fracture site through a subcutaneous tunnel (Figure 1E). At 90 days after surgery, the patient had normal limb function and no signs of infection. Minimally invasive surgical intervention was performed in order to dynamize the implant by the removal of the second and third screws (Figure 3E and 3F). Antimicrobial therapy was discontinued three days before the surgical re-intervention, and a new bacterial culture and antimicrobial susceptibility testing performed on the removed implants confirmed the absence of infectious agents. Upon full recovery of hindlimb function, absence of pain, no signs of infection, and total femur consolidation at 270 days after surgery, the patient was discharged

DISCUSSION

CONCLUSION