Negative Pressure Wound Therapy and Ultrasound Monitoring for Fracture-Related Infection of the Proximal Femur: A Case Report.

Background: Fracture-related infection (FRI) is one of the main complications of hip fracture. Negative pressure wound therapy (NPWT) seems to be a potential solution for FRI, because of offering exudate management, drainage enhancement, and tissue repair. Additionally, ultrasound cannot be ignored because of its role in evaluating musculoskeletal tissue infections. Case Presentation: A 55-year-old man mainly suffered from a fracture of the right proximal femur. The fracture was classified as AO/OTA 31-A3. The patient had a history of smoking. After internal fixation of the fracture and other symptomatic treatment, the patient was discharged. However, the surgical incision dehisced one month later. After examination, the patient was diagnosed with FRI with wound disruption and sinus tract formation. The blurred parafemoral shadow in X-ray, positive bacterial culture result, abnormal secretions, and elevated C-reactive protein and erythrocyte sedimentation rate were the bases for diagnosing FRI. In the course of treatment, we made full use of NPWT following limited debridement surgery to effectively treat FRI, and then continuously monitored the changes of lesions in deep infected areas through ultrasound detection. Intravenous infusion of ceftazidime and local rinsing with vancomycin solution were applied during the treatment process. Follow-up results showed that the patient had no recurrence of infection or other adverse events three months after treatment. Conclusion: This case shows that NPWT combined with ultrasound monitoring can control early fracture-related infection and allow implant retention. This treatment method may be applicable to areas with scarce medical resources. But larger-scale validation is still needed before clinical adoption.