Assessment of the efficacy of the multistage technique in the eradication of infection and achieving the union of traumatic infected femoral un-united shaft fractures in adult patients for one year follow up.

All cases will be treated by the induced membrane technique in two stages. In the first stage, thorough debridement of the infected bone and soft tissues and copious lavage will be done.

After radical debridement, primary fixation will be done by either external fixation or antibiotic cement coated internally fixed implants.If there is a bone defect, it will be measured and filled with an antibiotic-impregnated (PMMA) cement spacer. The second stage procedure will be performed 4 to 8 weeks after the first one if soft tissue permits and only if there is no clinical or biochemical evidence of ongoing infection as indicated by normal white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. It includes the exchange of the antibiotic cement spacer by a cancellous bone graft.

Inclusion Criteria:

1. Age between 18 and 65 years old.
2. Type 32 according to Arbeitsgemeinschaft für Osteosynthesefragen classification in adults.

Exclusion Criteria:

1. Patients with deficient soft tissue coverage with exposed bone.
2. Patients with reflex sympathetic dystrophy.
3. Spinal injuries associated with neurological complications affecting the lower limbs.
4. Associated head injury affecting the conscious level or the motor power of the injured limb.
5. Associated mutilating limb injury or peripheral amputation.
6. Bone defect more than 6 cm in length.
7. Chronic peripheral ischemia of the limb.
8. Past history of pathological fractures.

adult patient attending the department of orthopedics and traumatology, Assiut university with traumatic infected un-united femoral fractures.