Staged total hip arthroplasty using a handmade articulating spacer to manage bifocal-infected non-united femoral shaft and neck fractures. A case report and technical note

The coexistence of infected nonunion in both femoral shaft and neck fractures poses a multifaceted challenge, entailing complexities in approach, cost considerations, and management duration for both the orthopedic surgeon and the patient with limited documented evidence for appropriate management. This case report presents a distinctive instance of concurrent infected nonunion in femoral neck and shaft fractures. The treatment strategy involved a two-stage procedure. In the first stage, a handmade articulating antibiotic spacer was utilized to eradicate infection and achieve osseous union. Subsequently, a conventional primary total hip arthroplasty was performed to restore joint functionality. We suggest that this handmade spacer offers a cost-effective alternative, alleviating the economic burden associated with other revision modalities that tend to be more costly and technically demanding in such clinical scenarios.