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By David A. Spiegel

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Abduction splinting or casting failed uniformly if the femoral head and neck were absent, but was successful in 10/14 with at least a small head and neck remnant present. Arthrography is not helpful in determining the proximal femoral anatomy due to scarring. The study was prior to MRI, and surgical exploration was performed to assess the status of the femoral head and neck, and an open reduction is recommended in the prescence of a stable head and neck. Trochanteric arthroplasty was performed in 6 patients, 3 of whom remained located.

MRI was able to differentiate between the invasive and suppurative phases of the disease. Coexisting abnormalities in adjacent osseous or articular tissues were identified in 58% on MRI, and likely represent reactive inflammation rather than coexisting osteomyelitis. Percutaneous catheter drainage was successful in 5 cases, and may represent an alternative to surgical drainage in some locations. The optimal duration of antibiotic therapy remains unclear, however a combination of intravenous and oral antibiotics for 2-6 weeks was successful in all patients.

International Orthopaedics (SICOT) 19:238-241, 1995. Seventeen patients with large diaphyseal sequestra, and a variable degree of involucrum formation, were treated by surgical drainage, immobilization in plaster, and 6-8 weeks of antibiotics (IV and oral). Cases presented within 2-6 weeks of the onset of symptoms, and 10/ 17 had draining sinuses. Sixteen of seventeen demonstrated incorporation of more than 60% of the sequestrum, and 7 had near complete incorporation. In this setting, the authors do not recommend early sequestrectomy.

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