Abstract
BACKGROUND: The treatment of fracture-related infection (FRI) in the proximal femur presents a challenge due to the need to maintain both stability and function of the hip joint while eradicating the infection. This study aimed to analyze the outcomes of antibiotic-loaded bone cement(ALBC) combined with a locking plate for the treatment of these patients. PATIENTS AND METHODS: From January 2013 to January 2024, adult patients diagnosed with FRI in the proximal femur were included. All were treated with ALBC combined with a locking plate after debridement at our clinical center. Patients with a minimum of 2 years of follow-up, along with clinical and functional results, were retrospectively analyzed. RESULTS: A total of 83 consecutive patients were included. The initial osteosynthesis was with a nail in 56(67.5%) patients and with a plate in 27(32.5%). The S. epidermidis (20.5%) was the most common pathogen, followed by S. aureus (16.9%) and E. coli (14.5%). A staged reconstruction procedure was performed in 61 (73.5%) patients due to larger bone defects. After a median follow-up of 36 (range: 24-72) months, nine patients (10.8%) required additional revision, with seven due to recurrence and two due to nonunion. Infection-free bone union was achieved in all patients (100%) at the final follow-up. A significant increase in the Harris hip score (HHS) was observed, from a preoperative value of 65.7 ± 10.6 to a postoperative value of 84.3 ± 7.5 (P > 0.05). No cases of re-fractures or implant/cement spacer loosening were reported. Univariate analysis showed that prolonged infection duration, diabetes, and systemic diseases were associated with the additional revision. CONCLUSION: The use of ALBC combined with a locking plate served as a low-burden alternative in management of FRIs in the proximal femur, effectively reconciling infection eradication with functional preservation. Prolonged infection duration and increased comorbidities complicated the treatments.