Successful treatment of severe infection of the femur originating from pelvic abscess.

A 35-year-old man sustained multiple injuries including a fractured pelvis, a ruptured urethra, and a femur fractured at the neck, the shaft, and the supracondylar region. The fractured femur was grade IIIB open. Urethrography showed a ruptured urethra with extravasation of the dye into the upper thigh. Internal fixation of all femur fractures and the pelvis fracture was successful. A suprapubic cystostomy tube was inserted to manage the urethral tear. The tube became infected, and the infection extended from the pelvis into the thigh region, infecting the femoral fracture. The femur infection was thought to be a postoperative one that had originated locally. Computerized tomography (CT) scan was helpful in localizing the infection and its origin from the pelvis. Treatment included incision and drainage, with aggressive serial débridement of both abscesses. In addition, bone grafting of the femur was performed. The infection was controlled completely, and the patient returned to work 18 months after injury. The authors alert the orthopaedic surgeon to the possibility of this serious lesion, particularly when the initial urethrogram shows extension of the dye below the inguinal ligament.