Eighteen-year follow-up after rotationplasty for a grade IIIC open fracture of the distal femur

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

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Chemotherapy-Induced Oesophageal Stricture in a Child with Osteosarcoma: A Case Report

Chemotherapy Research and Practice ◽

10.1155/2010/240763 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3

Author(s):

Daichi Ishimaru ◽

Takatoshi Ohno ◽

Masato Maeda ◽

Yutaka Nishimoto ◽

Katsuji Shimizu

Keyword(s):

Case Report ◽

Balloon Dilatation ◽

Distal Femur ◽

Rare Complication ◽

Oesophageal Stricture ◽

Solid Foods ◽

Paediatric Case

Treatment with a combination of chemotherapy and radiotherapy is known to be associated with oesophageal stricture in both children and adults with malignancies. However, oesophageal stricture resulting from chemotherapy alone is a rare complication, with few reports on it. We experienced a rare paediatric case of oesophageal stricture caused by chemotherapy for osteosarcoma of the left distal femur. After completion of the chemotherapy course, the patient showed dysphagia caused by the oesophageal stricture and underwent balloon dilatation for the oesophageal stricture. After balloon dilatation, he was able to ingest solid foods, and the oesophagus was normal without any strictures at the last follow-up (20 months after ballooning). Therefore, oesophageal stricture should be considered as a complication of treatment with chemotherapy alone in children with malignancies.

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“FUNCTIONAL OUTCOME OF RETROGRADE NAILING IN THE MANAGEMENT OF SUPRACONDYLAR AND DISTAL FEMORAL FRACTURE”

10.36106/gjra/6411014 ◽

2021 ◽

pp. 107-109

Author(s):

Avinash Kumar Choudhary ◽

M.K Aseri ◽

Sumit Machra ◽

Devendra Singh

Keyword(s):

Femoral Fracture ◽

Distal Femur ◽

Femoral Fractures ◽

High Energy ◽

Valgus Deformity ◽

Minor Trauma ◽

Rating Score ◽

Joint Congruency ◽

Distal Femoral Fractures

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Proper diagnosis and treatment leads to early mobilization and rehabilitation of patients. MATERIAL AND METHODS :This prospective study was conducted in Department of Orthopedics at Dr. S. N. Medical College and Associated group of Hospital, Jodhpur ,Rajasthan ,India on 30 patients who underwent the surgery with retrograde intramedullary interlocking nail in the management of extra-articular supracondylar femoral fracture from August 2019 to November 2020. On follow up axial alignment was assessed and functional analysis was quantied using NEERS RATING SYSTEM, Radiographs was analyzed for correction, maintenance of position or loss of reduction. function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients. RESULTS: In our study 30 patients with supracondylar & distal femoral fractures based on AO Classication on MULLER ET AL underwent retrograde supracondylar nail, long term nal result were rated using NEER'S RATING SCORE , which gives point for pain, function, working, joint movement ,gross and radiological appearance. NEER'S RATING SCORE assigned for each patient after 24 weeks of follow up. After accessing this score out of total 30 patients, 10 have excellent score, 10 have good score, 8 have fair score and next 2 have poor score. Function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients,out of 30 patients 9 patients have an excellent result , 8 have good ,12 have fair and only 1 patient have poor result CONCLUSION:The retrograde intramedullary locked nail provides the surgeon with a different option in treatment of specic supracondylar fracture patterns. It offers a practical advantages of simple and efcient technique for patients with polytrauma, oating knee injuries and in elderly. this technique is very useful in distal femur fracture where antegrade nailing does not provide stability and also where plate xation is not suitable due to soft tissue condition.

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Surgical Resection with Boyd Technique for Metastatic Ewing Sarcoma of the Bone Plus Docetaxel/Gemcitabine, Associated with Improved Outcomes in Tumor Activity

Advances in Hematology and Oncology Research ◽

10.33140/ahor.03.01.12 ◽

2020 ◽

Vol 3 (1) ◽

Keyword(s):

Ewing Sarcoma ◽

Distal Femur ◽

Medical Oncology ◽

Femur Fracture ◽

Improved Outcomes ◽

History Of ◽

Metastatic Activity ◽

History Of Epilepsy ◽

Histopathological Result

Ewing sarcoma is a malignant bone tumor that mainly affects children, adolescents and young adults with more than 1.5 cases per million worldwide. Approximately 20-25% of patients present metastatic disease at the diagnosis, that is often resistant to intensive therapy.We present the case of a 19-year-old male with history of epilepsy who started his condition with weight loss, increased volume, pain, swelling after receiving surgical treatment due to a left distal femur fracture, showing tomographic evidence of a 50-cm tumor with multiple lung lesions, so disarticulation was performed with the Boyd technique, obtaining histopathological result of Ewing’s Sarcoma, and was subsequently sent to the medical oncology service for follow-up and adjuvant treatment with significant clinical and radiological improvement in pulmonary metastatic activity.

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Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

The Journal of Knee Surgery ◽

10.1055/s-0039-1688556 ◽

2019 ◽

Vol 33 (08) ◽

pp. 818-824

Author(s):

Joseph A. Ippolito ◽

Megan L. Campbell ◽

Brianna L. Siracuse ◽

Joseph Benevenia

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Tumor Resection ◽

Case Series ◽

Full Weight Bearing ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Optimal Function ◽

Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

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Megaprosthesis as a treatment modality for persistent distal femoral nonunion in middle aged adults

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00536 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0053

Author(s):

Shashank Agarwal ◽

Inder Pawar ◽

Anil Kumar ◽

Anjul Verma ◽

Pawan Kumar

Keyword(s):

Range Of Motion ◽

Treatment Option ◽

Knee Society Score ◽

Distal Femur ◽

Fracture Site ◽

Definitive Treatment ◽

Full Extension ◽

Non Union ◽

The Mean

Introduction: Managing distal femur non-union can be a struggle for any orthopedician as it brings along many perplexities which may not lead to satisfactory patient outcome. The target in these cases should be to reduce the morbidity and allow early rehabilitation of the patient and to accomplish this, megaprostheses can be a feasible option. The orthodox use of megaprostheses is in the musculo-skeletal oncologic surgeries but its use can be extended to traumatic etiologies. These can be offered as a single stage definite procedure in patients who have already undergone several previous surgeries. Here we report a series of four cases of persistent non-union of distal femur treated with megaprostheses and recommend this modality for achieving the desired goal but the indication should be meticulously selected. Hypotheses: Megaprosthesis as a definitive treatment option in persistent distal femur non-union and prevention of repeated surgical intervention. Methods: Four cases of persistent distal femur nonunion with failed osteosynthesis were selected who were initially treated with a distal femur locking plate. Results were assessed in terms of range of motion, limb length discrepancy, knee society score and osteointegration of the components. Results: The mean age of the patients at the time of DFEPR was 49 years (42-55). The mean follow up of patients was for approximately 2 years, with the longest follow up being 3.5 years for the first operated case of the series. The range of motion was from full extension to about 105 degrees of flexion with two patients having an extension lag of 10 degrees. Patients were ambulatory without support. Postoperatively, the mean knee society score was 83 (78–88) at last follow-up as compared to 29 (21-36) in the pre-operative period. No case of infection or loosening was reported. There was 1 cm of shortening in one patient in the operated limb which was compensated by giving shoe raise. Good osseointegration of the megaprosthesis was revealed on both anteroposterior and lateral radiographs. Conclusion: Although there are very limited studies on the use of megaprosthesis for traumatic cases, it can be considered as an alternative when we are left with only arthrodesis or amputation as the final option. Despite the operative challenges, there is marked improvement in pain and functional capacity as experienced by these severely limited patients, which are the hallmarks of a successful salvage. The use of distal femur mega-prosthesis is a novel acumen in cases, where bone stock at the fracture site at distal end of femur is so severely compromised that traditional revision osteosynthesis would not provide stable and durable fixation. The indications for this surgery must be rigorously selected and should only complement osteosynthesis procedures, which remain the reference treatment option.

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Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip

Hip International ◽

10.1177/1120700019863410 ◽

2019 ◽

Vol 30 (6) ◽

pp. 793-798 ◽

Cited By ~ 2

Author(s):

Kaushik Bhowmick ◽

Thomas Matthai ◽

Perumal Ramaswamy JVC Boopalan ◽

Thilak S Jepegnanam

Keyword(s):

Decision Making ◽

Functional Outcomes ◽

Intertrochanteric Fracture ◽

Distal Femur ◽

Femur Fracture ◽

Intertrochanteric Fractures ◽

Non Union ◽

Shaft Angle ◽

Head Shaft Angle

Aim: Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures. An algorithm for the management of these injuries is also proposed. Methods: 19 patients with intertrochanteric malunion and 12 patients with non-union were included in this study. Treatment of these injuries was initiated according to the algorithm proposed in this study. Treatment outcomes were evaluated by assessing union, pre and postoperative shortening and HSA (head-shaft angle). Functional outcomes were assessed by the Parker mobility scale and presence or absence of pain. Results: All the patients with intertrochanteric malunion with follow-up had united. The postoperative shortening in all patients were ⩽2.5 cms. Patients having intertrochanteric nonunion with follow-up, who underwent internal fixation had united with an acceptable Parker mobility scale score, except in 1 patient who sustained an ipsilateral distal femur fracture. The average HSA correction obtained was 21° (range 3–60°). Conclusion: The algorithm proposed in this study helps streamline the treatment according to each case scenario.It helps in planning and managing patients with intertrochanteric fracture failures.

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Simultaneous Symmetrical Bilateral Bimalleolar Open Fracture with Ankle Dislocation by Indirect Injury – Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0011.5880 ◽

2018 ◽

Vol 20 (1) ◽

pp. 51-55

Author(s):

Asif Sultan ◽

Maajid Shabir ◽

Mufti Mehmood ◽

Qazi Waris Manzoor

Keyword(s):

Coming Out ◽

Open Fracture ◽

Operative Management ◽

Probable Mechanism ◽

Distal Fibula ◽

Indirect Trauma ◽

Free Function ◽

Indirect Injury

A rare case of symmetrical open bimalleolar fractures with bilateral dislocation of ankles is described. A 30-year-old man sustained indirect trauma working in squatting position with a heavy log of wood falling on his knees with ankles in inversion, and sustained symmetrical open III B bimalleolar fractures with dislocation of bilateral ankles with the distal fibula coming out of the skin. The patient underwent operative management on bilateral ankles and the post-operative course was uneventful. The patient had no complaints at 4 years’ follow-up and had a full, pain-free function. The probable mechanism of the fracture is discussed.

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Successful Limb-Sparing Wide Excision of a Giant Lipofibromatosis in a 5-Year-Old Girl

Case Reports in Oncology ◽

10.1159/000487476 ◽

2018 ◽

Vol 11 (1) ◽

pp. 179-184

Author(s):

Putu Anda Tusta Adiputra

Keyword(s):

Operating Room ◽

Distal Femur ◽

Surgical Decision ◽

Left Tibia ◽

Course Of Action ◽

Left Limb ◽

Set Up ◽

Painless Mass ◽

Bony Erosion

A 5-year-old girl presented with a big painless mass, sized 24 × 37 × 35 cm, in her lower left limb. MRI revealed a huge heterogeneous mass splaying from the left distal femur to the calcaneal region without bony erosion but compressing the arteries and causing bowing of the left tibia and fibula bones. The difficulty was to determine the best course of action taken which would either be limb salvation or amputation. Considering that only a few muscles could be saved, the author initially recommended amputation but still considered a limb-sparing procedure. After a double set-up examination in the operating room, the author ultimately decided to save the affected limb. The salvaged limb was found to be viable after the surgery, and there was no further recurrence over a subsequent 6-month follow-up period. The careful surgical decision is vital in giving the best possible care to the patient.

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