One-stage revision surgery to treat hip infected nonunion after stabilization with a sliding compression screw.
BACKGROUND
Extracapsular hip infected nonunion after stabilization with a sliding hip screw (SCS) is uncommon and a convincing treatment method has not yet been reported in the literature.


METHODS
Thirteen consecutive patients who sustained such a disability were treated with removal of SCS, local radical debridement, vancomycin powder with or without gentamicin solution application, re-insertion of a new SCS, and autogenous cancellous bone grafting. Postoperatively, ambulation with regulated weight bearing was encouraged as early as possible. Infectious microorganisms in 76% (10/13) of the lesion sites were oxacillin-resistant staphylococcus aureus (ORSA).


RESULTS
Twelve patients were followed-up for at least 2 years (range, 2~6 years; median, 4 years) and all nonunions healed. The union rate was 100% (12/12) with a median union period of 4 months (range, 3~6 months). No wound infection recurred at the last follow-up. The satisfactory rate of hip function was 92% (11/12, P<0.001).


CONCLUSIONS
We, therefore, recommend this surgical procedure to treat all patients with a similar disability because of its high success rate and low complication rate.
Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin St. 333, Kweishan, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
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Wu
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Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D003646:Debridement; D005260:Female; D005599:Fractures, Ununited / Q000382:microbiology / Q000601:surgery*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011446:Prospective Studies; D012086:Reoperation; D013530:Surgical Wound Infection / Q000601:surgery*