Year 2018 Vol. 26 No 4

CASE REPORTS

I.M. EFREMOV, F.YA. SIBAEV

MEDULLOSCOPY IN THE TREATMENT OF COMPLICATIONS OF INTRAMEDULLARY OSTEOSYNTHESIS WITH AN ANTIMICROBIAL COATING NAIL (CLINICAL CASE)

Ulyanovsk State University, Ulyanovsk, The Russian Federation

One of the ways to treat patients with open fractures and infected false joints of long tubular bones is intramedullary osteosynthes is with antimicrobial-coated nails. Among the possible complications of this type of osteosynthesisis the rarely encountered and little-lit migration of the antimicrobial coating of the nail.
A clinical case of treatment of a patient with chronic osteomyelitis of the femur is presented, the recurring course of which was caused by the presence of a cement mantle from an intramedullary nail with antimicrobial coating. With the aim of arresting the osteomyelitic process, radical debridement and removal of the cement mantle from the medullary canal were performed. To further "sterilize" the surgical wound, an ultrasonic cavitation of the wound in a solution of gentamicin was performed, as well as treatment with the pulse-lavage system. Additionally, muscular hernia of m. quadriceps femoris was eliminated by mobilizing and suturing the fascia lata. In order to control the sanitation of the medullary canal, the medulloscopy of the right femur was performed by a flexible video endoscope. The endoscope was introduced in the medullary canal through the exposed and treated osteomyelitiscavity in the middle third of the femur. The patient was examined 1.5 years after the operation. As a result of the treatment, a stable remission of chronic osteomyelitis had been achieved.
Medulloscopy of a long tubular bone is a promising method of quality control of surgical sanitation. Migration of cement mantle is a rare complication, which must be taken into account when implanting and removing the intramedullary nail with antimicrobial coating.

Keywords: medulloscopy, intramedullary nail with antimicrobial coating, cement mantle, osteomyelitis, fracture fixation
p. 491-495 of the original issue
References
  1. Gurin NN. Lechenie lozhnykh sustavov, oslozhnennykh osteomielitom. S-Petersburg, RF; 2004. 272 p.
  2. Shevtsov VI, Makushin VD, Pozharishchenskii KE. Lechenie bolnykh s defektom bolshebertsovoi kosti metodom rekonstruktivnoi tibializatsii malobertsovoi. Kurgan, RF: Periodika; 1994. 256 p.
  3. Ivanov PA, Sokolov VA, Byalik EI, Didenko OA, Nevedrov AV. Use of Intramedullar locking nails with active antibacterial coating for the treatment of severe open fractures and their complications. Vestn Travmatologii i Ortopedii im NN Priorova. 2009;(1):13-18.
  4. Kuropatkin GV, Akhtiamov IF. Kostnyi tsement v travmatologii i ortopedii. 2-e izd. Kazan, RF: TaGraf; 2014. 188 s.
  5. Mendicino RW, Bowers CA, Catanzariti AR. Antibiotic-coated intramedullary rod. J Foot Ankle Surg. 2009 Mar-Apr;48(2):104-10. doi: 10.1053/j.jfas.2008.06.010
  6. Schnettler R, Steinau HU. Septic Bone and Joint Surgery. Thieme: Stuttgart; 2010. 328 p.
  7. Thonse R, Conway JD. Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects. JBJS. 2008 Nov;90(Is):163-74. doi: 10.2106/JBJS.H.00753
  8. Amiraslanov IuA, Svetukhin AM, Borisov IV, Ushakov AA. Surgical tactics in treatment of osteomyelitis of long bones. Khirurgiia Zhurn im NI Pirogova. 2008;(9):46-50.
  9. Zalavras CG, Singh A, Patzakis MJ. Novel technique for medullary canal débridement in tibia and femur osteomyelitis. Clin Orthop Relat Res. 2007 Aug;461:31-34. doi: 10.1097/BLO.0b013e318098673f
  10. Roberts CS, Walker JA, Statton J, Seligson D. Medulloscopy for sepsis or nonunion: early clinical experience with the tibia and femur. Arthroscopy. 2001 Nov-Dec;17(9):E39. doi: 10.1053/jars.2001.26920
  11. Kwak JH, Sim JA, Yang SH, Kim SJ, Lee BK, Ki YC. The use of medulloscopy for localized intramedullary lesions: review of 5 cases. Arthroscopy. 2009 Dec;25(12):1500-4. doi: 10.1016/j.arthro.2009.01.009
  12. Oberst M, Bosse A, Holz U. Intramedullary fracture reduction of long bone under visual control: experimental results of an endoscopic technique. Arthroscopy. 2006 Jun;22(6):686.e1-5. doi: 10.1016/j.arthro.2006.02.003
  13. Arora S, Maini L, Aggarwal V, Dhal A. Broken guidewire protruding into the hip joint: a bone endoscopic-assisted retrieval method. Indian J Orthop. 2012 Jan;46(1):109-12. doi: 10.4103/0019-5413.91646
  14. Roberts CS, Statton JO, Walker JA, Seligson D, Hempel D. Medulloscopy of the tibia: initial report of a new technique. Arthroscopy. 2000 Nov-Dec;16(8):865-68. doi: 10.1053/jars.2000.19651
  15. Oberst M, Bosse A, Holz U. Intramedullary pressure during endoscopy of the long bone: experimental results of a new endoscopic technique. Arthroscopy. 2004 May;20(5):552-55. doi: 10.1016/j.arthro.2004.03.013
Address for correspondence:
432017, The Russian Federation,
Ulyanovsk, Leo Tolstoy Str., 2,
Ulyanovsk State University,
Department of Hospital Surgery,
Tel.: +7 917 612 41 77,
e-mail: efremov-im@rambler.ru,
Ivan M. Efremov
Information about the authors:
Efremov Ivan M., PhD, Senior Researcher, Department of Scientific Research, Associate Professor of the Department of Hospital Surgery, Anesthesiology, Reanimatology, Urology, Traumatology and Orthopedics, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-4625-8424
Sibaev Farid Ya., Laboratory Assistant Researcher of the Department of Scientific Research, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-7009-8192
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