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Interval Technique for the Management of Distal Femoral Defects and Infection


History


68 yr old, 52kg female underwent TKA for OA knee 8 years ago. She had polio in the past and has no quadriceps function. Her knee was placed in slight hyperextension and she did well walking without aids or braces. In November 2008, she fell while in Mexico. She sustained a high supracondylar fracture, initially managed with an external fixator. This was later converted to a supracondylar retrograde nail.

Physical Examination


The patient was seen 7 months later with a stiff, painful, swollen and warm knee. She had been on intravenous antibiotics and was taking oral cephalosporins at the time. ESR was 37 and CRP was 20.5. Her cell count was 7750, with 90%polys. Antibiotics were stopped and she was aspirated 3 weeks later, no growth.

Initial Imaging

Initial imaging studies are shown below


What is the differential diagnosis?



















Diagnosis (Click to see answer)

Treatment

Discussion

References




Corresponding Author

Chris Estes
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