Prospective Role of Uniplanar Compressible External Fixation Devices in Management of Pathological Diaphyseal Fractures

Introduction: Management of pathological diaphyseal fractures secondary to osteomyelitis in children still remains a nightmare for the treating orthopedic surgeon owing to the highly unpredictable clinical course and lack of certainty in achieving successful results. This study highlights the potential role of rail fixator in the management of pathological femur fracture secondary to osteomyelitis in children. Materials and methods: A total of five children (8–13 years age group) with pathological diaphyseal fractures of femur (four cases) and tibia (one case), operated between January 2014 and December 2014, were included in the study. Chronic osteomyelitis was the underlying etiology in all the cases. The surgical management consisted of thorough debridement, lavage, freshening of fractured bone ends, opening of the bone ends, reduction and external stabilization using pediatric monorail fixator. All patients received postoperative antibiotics, based on intraoperative culture and sensitivity reports, for 6 weeks (intravenously for the initial 3 weeks, orally for the remaining 3 weeks). Weight bearing and knee range of motion were started in the early postoperative period as soon as the children were pain free. Results: Staphylococcus aureus was the causative organism in all the cases. Out of five cases, four fractures united: Three femurs (between 9 and 12 weeks) and one tibia (11 weeks). There was one case of delayed union of femur (18 weeks). Septic pin tract loosening was seen in one case (femur) requi­ ring prolonged antibiotic usage. Minimal limb length discrepancy (1–1.5 cm) was observed in all the cases. Conclusion: Compression fixation achieved by monorail fixator can be considered as a viable option for the management of pediatric diaphyseal fractures secondary to active bony infection. It has the advantage of promoting bony union, aiding in early weight bearing, establishing successful joint mobilization, providing an option for future restoration of limb length, and improved patient comfort. j