Fig. 3.

Day 31 after the injury. Infection with Enterobacter cloacae was confirmed. The patient was using an antibiotic (meropenem) chosen on the basis of culture and had already undergone 3 debridements. Fig. 3-A Preoperative appearance of the soft tissue. Fig. 3-B Intraoperative photograph showing infection in the medullary canal. The intramedullary nail was removed, and the canal was reamed. Debridement of bone and soft tissue resulted in a partial bone defect with an estimated size of 6 cm (12 cm involving 50% of the bone diameter). Fig. 3-C Postoperative radiograph. An intramedullary PMMA-with-antibiotic spacer (2 g of meropenem per 40-g package of PMMA) was used in the bone defect. (A smaller spacer was used in this case with active intramedullary infection to allow drainage of the canal). An external fixator was applied to provide bone stability.