Introduction: This case presentation demonstrates the management of chronic osteomyelitis and knee arthrofibrosis via débridement, insertion of an antibiotic nail, and Judet quadricepsplasty.

Methods: The patient shown in this video is a 43-year-old man who who underwent plate fixation of a right femoral shaft fracture in a foreign country 16 years ago. In the past year, he has experienced progressively worsening knee range of motion with episodes of intermittent drainage. He underwent arthroscopic lysis of adhesions, which resulted in no improvement in knee range of motion. At the time of presentation, knee range of motion was from 0° to 5°. Infection markers were consistent with chronic osteomyelitis.

Results: Given the patient's history of open plating of a femoral shaft fracture, adhesions likely developed between the quadriceps and the femur at the site of previous surgery. Therefore, Judet quadricepsplasty of the right femur to increase knee range of motion and irrigation and débridement of the thigh compartment, including the intramedullary canal of the femur, with associated antibiotic nail placement in the femoral canal were indicated. Judet quadricepsplasty consists of a stepwise release of the structures around the knee, thigh, and hip to release a flexion contracture of the knee. The indication for Judet quadricepsplasty is a flexion contracture of the knee caused by a combined contracture of the anterior knee joint capsular structures and adhesions of the quadriceps to the femur. Typically, the former is a result of the latter.

Conclusion: The infection was eliminated after the use of antibiotic agents for 6 weeks, and the antibiotic nail was removed at 3 months postoperatively. At 1 year postoperatively, the patient had symmetric and full knee range of motion, with no sign of recurrent infection.