No abstract

A series of 1871 lesions of the upper end of the femur were treated in 32 hospitals in Belgium using a dynamic hip screw. Unstable pertrochanteric fractures were present in 34.4%. The remainder were intracapsular, extracapsular and subtrochanteric fractures, or tumour deposits. The patients were elderly, infirm and usually female. A fortnight after operation 89% were sitting, 64% could walk with a frame and 31% with crutches. Failure of fixation occurred in 3.6% of cases overall, with 6.6% in unstable fractures. Perioperative screw compression did not appear helpful, since most fractures settled after operation.

The detection of metastatic deposits at the site of previous osteosynthesis is difficult. Bone imaging and scanning with technectium 99m are unhelpful in differentiating between osteomyelitis, Paget's disease and a bone metastasis. The authors present details of a patient who had undergone osteosynthesis for a fracture of the left tibia in 1983. In October 1989 signs of inflammatory change appeared at the site of the previous fracture. It was initially treated as if it were osteomyelitis, with curettage and insertion of gentamycin beads, although no organisms were grown. Eventually the patient was transferred to the author's hospital and further investigation revealed a carcinoma of the prostate. Histological examination of biopsy specimens from the left tibia confirmed the presence of a metastasis from this growth.

We report a case of acute haematogenous osteomyelitis of the lower part of the femur in a 44 years old woman, associated to an infectious arthritis of the knee. These observations are rather rare in adults. Few cases of similar association have been published. Our observation is particuliar for two reasons: 1) the knee infection occurred some days after the bone infection, not in the same time. 2) The pus culture have remained negative. We think that this case is to begin the discussion about the physiopathogeny of the joint contamination. We think that the joint have been contaminated by proximity of an infected necrotic bone, more than an haematogenous way. Such a dramatic evolution for the bone infection and the negativity of the cultures are to be related with the possibility of anaerobic germs.