Osteosynthesis in a Child with Infected Non-Union Nof, Neck Resorption, Avn & Implants Insitu—A Case Report
Non union is one of the commonest complications of intra-capsular fracture neck of femur in children as well as in adults and it is the most challenging problem to treat if femoral head salvage is attempted. Another common complication is avascular necrosis (AVN) of the femoral head with most reported incidences being <15% (range 0% to 67%), which is similar to the complication rate with non-neglected femoral neck fractures. We are reporting a case of a 10 year old boy who underwent closed reduction and internal fixation with cannulated cancellous screws elsewhere, for Delbert type III fracture neck of femur, which subsequently got infected with a draining sinus, and went in for non-union and AVN of femoral head, with complete resorption of the neck in 4 months time. We received the patient at that stage. He was managed by two stage surgery. Initially the implants were removed, the screw tracks curetted out and filled with antibiotic sponge. After the infection was eradicated, osteosynthesis and neck reconstruction was done using fibular strut and cancellous grafts through modified Watson Jones approach and anterior capsulotomy. We avoided metal implants for fear of infection, and therefore also a subtrochanteric osteotomy. A hip spica cast was given for 6 weeks. The neck length was restored, vascularity restored and fracture united with an excellently functioning hip.