One-stage versus Two-stage Protocol in Management of Infected Nonunited Fracture Femur

Abstract

his double-armed, comparative, interventional, pilot study was conducted at Orthopaedic Surgery department Ain Shams University Hospital and Embaba General Hospital from September 2017 to September 2020. The study aimed to compare between the results of protocol of one-stage management (application of external fixation technique) and two-stage management (debridment, removal of metal, and another stage of internal fixation after eradication of infection) in the management of cases of infected non-united fracture femur. Twenty patients who met the inclusion criteria were grouped into two groups: one-stage protocol group 10 cases and two-stage protocol group 10 cases. There was no significant difference between the two study groups with regard to the age. There was no significant difference between the two study groups with regard to gender. Males constituted 80% & 70% of cases in the one-stage group & the two-stage group, respectively. Duration of septic non-union were comparable between both groups. The mean duration was 23.4±10.0 and 22.9±9.7 months for the one-stage group & the two-stage group, respectively. Both groups were comparable with regard the level of infected non-union. Most cases in the one-stage group had distal fracture whereas half (50%) of the two-stage group had shaft fracture. Fixation by nail then plate was used in 60% of cases and plate then plate in 40% of the two-stage group, while fixation with plate then ilizarov was used in 70% of cases and nail then ilizarov in 30% of cases of the one-stage group. The healing time was comparable between groups. It was 8.6±2.5 and 8.4±1.7 months for the one-stage group & the two-stage group, respectively. There was a significant difference between the two study groups with regard to the range of movement of knee 6-months after healing. The median (IQR) range of movement of knee was 100 (50) and 110 (30) degrees for the one-stage group & the two-stage group, respectively. However, the change in ROM before and after management was non-significant between the two study groups. The range of motion of the knee was the same in 90% & 20% for the one-stage group & the two-stage group, respectively.