ONE-STAGE VERSUS TWO-STAGE PROTOCOL IN MANAGEMENT OF INFECTED NONUNITED FRACTURE FEMUR; RANDOMIZED CONTROLLED TRIAL

Background: The rate of complex fracture non-unions is increased. Infected non-united fractures need more search for the best method of management.Aim of the work: to compare one-stage protocol (external fixation) and two-stage protocol (debridement, removal of metal, and internal fixation after eradication of infection) in cases of infected non-united fracture femur.Patients and methods: The study was conducted at the Orthopaedic Surgery department Ain Shams University Hospital and Embaba General Hospital from Sep-2017 to Sep-2020 on 20 patients grouped into: one-stage protocol 10 cases and two-stage protocol 10 cases.Results: There was no significant difference between groups concerning age and gender. The healing time was 8.6±2.5 and 8.4±1.7 months for the one-stage group & the two-stage group, respectively. The range of motion of knee six months after healing was significantly (p-value = 0.025) better in the two-stage group. The median (IQR) range of movement was 100 (50) and 110 (30) degrees for the one-stage group & the two-stage group, respectively. The most frequent complication in the one-stage group was PTI (100% of cases); however, in the two-stage group, it was the recurrence of infection (30%), (p-value = 0.01).Conclusion: The two-stage strategy had a better range of motion of knee, less period of immobilization, better psychological status six months after healing but had a higher risk of recurrence of infection.