A case of chronic osteomyelitis after flexible intramedullary nailing of the femur in 14-year-old boy

This report presents a case of chronic osteomyelitis occurring in a young adolescent, following a left midshaft femoral fracture that was treated with flexible intramedullary nailing. Appropriate therapy for chronic osteomyelitis complicating a fracture is based on a multimodality approach even if there is no set algorithm to take in charge the two central problems related to it, namely the eradication of infection and the osseous union. The surgical technique and choice of fracture fixation should be determined according to the patient's weight and age. Careful monitoring after surgery is important. Clinical signs and investigations should alert the surgeon to the possibility of an underlying infection, and appropriate treatment should be undertaken promptly. It is important not to underestimate local skin irritation or inflammatory results that remain elevated. If a nail has penetrated through the skin and the fracture has united, metalware should be removed promptly as the risk of developing osteomyelitis is high even in an otherwise healthy child. © Springer-Verlag 2012.