The "turn-up" plasty: one solution to a complex problem.

This case study presents a patient with severe osteomyelitis of the femur, which did not respond to vigorous antibiotic therapy. Compromised kidney function, malnutrition, and copious drainage from an open wound led the patient and physician to select a seldom used procedure, the "turn up" plasty to treat the problem. This procedure provides a stump for an above-the-knee prosthesis providing the patient with more optimal function than if the femur and lower leg were amputated. The procedure involves removal of the infected femur, foot amputation, knee disarticulation and turning the lower leg up, using the tibia to support the femoral component of a joint replacement. After several months, the patient is wearing a prosthesis, walking without pain, and satisfied with his decision.