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Abstract
The authors report a case of necrosis occurred after diaphyseal femoral intramedullary nailing. The objective of the study was to describe the difficulties of interpretation of radiographs that could suggest a postoperative osteitis. The patient, aged 14 and heterozygous sickle (AS) had received nailing open fire following a highway accident that resulted in a fracture of the femur. Post pictures - operative cortical lysis had suspected osteitis. The absence of clinical signs and scintigraphic images were allowed to establish the diagnosis of diaphyseal aseptic necrosis. The removal of the nail without further treatment was followed by a rapid normalization of radiographic images.
RÉSUMÉ
Les auteurs rapportent un cas de nécrose diaphysaire fémorale survenue après enclouage centromédullaire. L’objectif du travail était de décrire les difficultés d’interprétation de radiographies qui auraient pu laisser penser à une ostéite post opératoire. La patiente, âgée de 14 ans et drépanocytaire hétérozygote (AS) avait bénéficié d’un enclouage à foyer ouvert à la suite d’un accident de la voie publique ayant entrainé une fracture du fémur. Les images post - opératoires de lyse corticale avaient fait suspecter une ostéite. L’absence de signes cliniques et les images de scintigraphie avaient permis d’établir le diagnostic de nécrose diaphysaire aseptique. L’ablation du clou sans autre traitement avait été suivie d’une normalisation rapide des images radiographiques.
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References
- Timmerman LA, Rab GT. Intramedullary nailing of femoral shaft fractures in adolescents. J Orthop Trauma; 7(4):331-337, 1993.
- Clinkscales CM, Peterson HA. Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods.
- Orthopedics 1997; 20(12):1131-1136.
- Gonwalez Herranz P, Burgos Flores J, Rapariz JM, Lopez Mondejar JA, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg Br 1995; 77(2) : 262-266.
- Pfeifer R, Sellei R, Pape HC. The biology of intramedullary reaming Injury. 41 Suppl 2010: S4-8.
- Golpen G, Wilson JA, Mcaffrey M, Deluzio K et al. A cadaver model evaluating femoral intramedullary reaming: a comparison between new reamer. design (Pressure Sentinel) and a novel suction/irrigation reamer (RIA); Injury. 41 Suppl 2, 2010: S38-42.
References
Timmerman LA, Rab GT. Intramedullary nailing of femoral shaft fractures in adolescents. J Orthop Trauma; 7(4):331-337, 1993.
Clinkscales CM, Peterson HA. Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods.
Orthopedics 1997; 20(12):1131-1136.
Gonwalez Herranz P, Burgos Flores J, Rapariz JM, Lopez Mondejar JA, et al. Intramedullary nailing of the femur in children. Effects on its proximal end. J Bone Joint Surg Br 1995; 77(2) : 262-266.
Pfeifer R, Sellei R, Pape HC. The biology of intramedullary reaming Injury. 41 Suppl 2010: S4-8.
Golpen G, Wilson JA, Mcaffrey M, Deluzio K et al. A cadaver model evaluating femoral intramedullary reaming: a comparison between new reamer. design (Pressure Sentinel) and a novel suction/irrigation reamer (RIA); Injury. 41 Suppl 2, 2010: S38-42.