31-year-old female with metabolic bone disease who sustained a displaced right femoral neck fracture and a left femoral neck stress fracture after a low-energy fall. Initial surgery included ORIF with a sliding hip screw construct on the right side and placement of a prophylactic sliding hip screw on the left side to prevent fracture completion and displacement. She presented 6 months later with a left sided deep infection, nonunion of her stress fracture and persistent pain.
Stage 1: The sliding hip screw was removed from the left femur and multiple meticulous excisional debridements were performed. 20cc of STIMULAN paste was injected into the proximal femur bone void. Bacterial cultures revealed Propionibacterium Acnes. Antibiotic treatment was administered based on the sensitivities of the organism and I.V. antibiotics were administered for 6 weeks following surgery.
Stage 2: At 6 weeks, autologous bone graft and 10cc of STIMULAN paste were placed at the femoral neck nonunion site. Internal fixation was performed with a blade plate device.
6 weeks after stage 1 treatment, the patient was free from infection with complete absorption of STIMULAN paste. 4 months after stage 2 treatment, the nonunion site appeared to be healed with no hardware failure and complete absorption of STIMULAN. Imaging at 1 year after stage 2 treatment confirmed consolidation at the nonunion site and stable hardware.
The patient developed heterotopic ossification in her vastus lateralis due to multiple debridement surgeries to treat her infection and extensile distal dissection required to place the blade plate. The heterotopic ossification was asymptomatic and did not require further treatment. At 2 years, the patient is ambulating without an assisted device and remains infection and pain free.
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