Description of Event or Problem · 1
A REPORT WAS RECEIVED INVOLVING IMPLANT. HYDROXYAPATITE BONE VOID FILLER BLOCK WAS USED TO REPAIR A SEVERELY COMMINUTED (SCHATZKER TYPE IV) PROXIMAL TIBIAL FRACTURE. THE PT DEVELOPED A NECROTIC WOUND DEHISCENSE APPROX 3 WKS POST-OPERATIVELY. THE DR STATED THAT THE PT'S HEAVY SMOKING HABITS CAUSED THE DEHISCENSE. THE PT RETURNED TO THE HOSP 3 TIMES FOR IRRIGATION AND DEBRIDEMENT. FOLLOWING THE LAST DEBRIDEMENT THE WOUND WAS CLOSED USING A FREE VASCULAR RECTUS GRAFT TRANSFERRED TO THE DEHISCENSE SITE. THE WOUND HEALED BUT CONTINUED TO DRAIN. THE PT WAS PLACED ON A 6 WK I.V. COURSE OF ANTIBIOTICS AND WAS DISCHARGED HOME. THE PT THEN CONTINUED ON ORAL ANTIBIOTICS. ADD'L SURGERY ON 6/20/96, NOTED INFECTION AND BONE NECROSIS. A CULTURE TAKEN AT THE TIME OF SURGERY TESTED POSITIVE FOR PEPTOSTREPTOCOCCUS. THE FILLER, LATERAL PLATE AND SCREWS, AND NECROTIC BONE WERE REMOVED. THE DR STATED THAT ALTHOUGH THE PRESENCE OF PRO OSTEON MAY HAVE EXACERBATED THE INFECTION (I.E. AN AREA WHERE THE INFECTION MIGHT HARBOR), THE SAME OUTCOME WOULD HAVE BEEN REACHED USING AUTOGRAFT THAT ULTIMATELY DID NOT VASCULARIZE.