51-year-old male diabetic and smoker 6 months after internal fixation of pilon fracture presented with persisting non-healing fracture, discharging sinuses and implant related osteomyelitis.
The metalwork together with the infected/dead soft tissues were removed. At the same stage the infected pin sites were over-drilled and 10cc of STIMULAN Rapid Cure mixed with antibiotic was applied as a paste using a syringe to fill the resulting dead space (Overdrill and Fill Technique). A spanning external fixation was added to provide stability and skin cover was provided from a plastic surgeon with a local flap. Microbiology and histology data confirmed infection with Gram-negative Klebsiella oxytoca. At 3 months the external fixator was removed, a Sarmiento weight bearing plaster was applied for 2 months followed by a fracture boot for 3 more months.
At 6 months imaging showed healing of the fracture and complete absorption of the STIMULAN paste. At 14 month follow-up the patient remains infection free, no re-fractures, walking with no pain.
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