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Khirurgii

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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
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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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