Single-stage surgery for complex chronic femoral osteomyelitis: A case report

Chronic femoral osteomyelitis remains a major limb-salvage challenge, particularly when compounded by recurrent fractures and failed reconstructive attempts. We report a striking case of a 42-year-old diabetic man who endured a nearly decade-long disease course marked by three pathological femoral fractures, recurrent sinus formation, and failure of three previous limb reconstruction systems (LRS) external fixators, despite multiple surgical debridements, bone transport, and prolonged antibiotic therapy. At the most recent presentation, he presented with sepsis, a femoral malunion, and a persistent intramedullary infection. The team achieved definitive management using a single-stage approach that included extensive debridement, intramedullary reaming, local delivery of antibiotic-loaded bioabsorbable calcium sulfate beads (Stimulan), and stabilization with an LRS external fixator. This strategy resulted in successful infection control, fracture union, and limb preservation without recurrence. This case illustrates that a carefully planned single-stage surgical strategy can achieve durable outcomes even after multiple failed reconstructions in refractory chronic femoral osteomyelitis.