Knee sepsis after suprapatellar nailing of an open tibia fra
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Open tibia fractures are relatively common injuries that can be challenging to treat. Stabilization of these fractures is often performed with intramedullary nailing (IMN), a technique that involves implant placement through either a suprapatellar or infrapatellar portal.

The present case has been reported in the Case Reports in Orthopedics. A 31-year-old male was involved in a dirt bike accident and sustained an isolated type II open mid-distal tibia fracture. The patient underwent suprapatellar intramedullary nailing and subsequently developed knee sepsis.

This patient was managed with irrigation and debridements of the knee, fracture site, and intramedullary canal. A resultant soft-tissue defect over the fracture site obviated primary closure. Creation of an acute deformity stabilized by a Taylor spatial frame allowed primary wound closure. After soft tissue healing occurred, the frame was used to correct the intentional deformity and maintain reduction until full healing occurred.

Case highlights:-
• While the use of either a rotational flap or free-tissue transfer remains the standard of care, the factors that may limit its use include lack of access to a microvascular surgeon, patient preference, or patient is not a candidate for such a soft-tissue procedure.

• The current report further highlights that acute shortening with angular deformity can be effective and avoid the need for flap. In this case, the factors that permitted the technique to work included a soft-tissue void that could be primarily closed without compromising vascularity to the foot and having a fibula fracture at a level near that of the tibial injury to allow deformity in the direction of soft tissue loss.

• Finally, given the intraoperative findings in this case, it is important to highlight the importance of meticulous debridement with wide excision of the involved soft tissue and bone in the surgical management of any open fracture.

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