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

This report presents a case of chronic osteo- 9 myelitis occurring in a young adolescent, following a left 10 midshaft femoral fracture that was treated with flexible 11 intramedullary nailing. Appropriate therapy for chronic 12 osteomyelitis complicating a fracture is based on a mul- 13 timodality approach even if there is no set algorithm to take 14 in charge the two central problems related to it, namely the 15 eradication of infection and the osseous union. The surgical 16 technique and choice of fracture fixation should be deter- 17 mined according to the patient’s weight and age. Careful 18 monitoring after surgery is important. Clinical signs and 19 investigations should alert the surgeon to the possibility of 20 an underlying infection, and appropriate treatment should 21 be undertaken promptly. It is important not to underesti- 22 mate local skin irritation or inflammatory results that 23 remain elevated. If a nail has penetrated through the skin 24 and the fracture has united, metalware should be removed 25 promptly as the risk of developing osteomyelitis is high 26 even in an otherwise healthy child.