Limb Salvage in Infected Femoral Nonunion Using the Ilizarov Technique

Treatment of an Infected Femoral Nonunion Using the Ilizarov Method

1. Medical History and Background (Patient with Multiple Previous Surgeries)
The patient presented with a complex case of infected femoral nonunion, following several failed initial surgical procedures:

Initial treatment: Internal fixation using a plate and screws.

Outcome: Removal of the plate due to hardware failure and infection of the surgical site.

Second-stage treatment: Application of a linear external fixator associated with a minimal temporary treatment (Monster).

2. Surgical Management and Therapeutic Strategy
Due to persistent infection, the presence of bone sequestra, and a major bone defect, the patient was managed according to a multi-stage strategy based on the Ilizarov method:

Stage 1: Debridement and Limb Shortening
– Extensive fistulectomy and sequestrectomy (removal of all necrotic and infected bone tissue).
– Significant femoral shortening of approximately 12 cm to bridge the bone defect, bring healthy bone ends into contact, and achieve infection control.

– Application of a circular Ilizarov external fixator.

Stage 2: Reconstruction Using the Ilizarov Method
– Performance of a distal femoral osteotomy to initiate distraction osteogenesis (gradual bone lengthening).

3. Clinical and Radiological Outcome
The postoperative course was particularly favorable, allowing all therapeutic objectives to be achieved:
– Infection control: Complete eradication of the infectious focus through the initial debridement.
– Bone union: Successfully achieved at the site of the femoral nonunion.
– Bone regeneration: Progressive lengthening at the distal osteotomy site functioned perfectly.
– Limb length restoration: The patient fully recovered the original length of the lower limb (compensating for the 12 cm shortening).

Conclusion
At follow-up, treatment using the Ilizarov method successfully salvaged the limb of this patient who had undergone multiple previous surgeries. An excellent functional recovery was observed, with full weight-bearing ambulation and definitive bone healing. The infection is considered cured.

Final radiograph showing fracture union and regeneration of 12 centimeters of bone