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

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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Distal Femur Tumor Megaprosthesis for Non-union of Supracondylar Femur Fracture after Failed Osteosynthesis. An Ingenious Solution.

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i09.2396 ◽

2021 ◽

Vol 11 (9) ◽

Author(s):

Bikram Kesari Kar ◽

Mukund Madhav Ojha ◽

Sandeep Kumar Yadav ◽

Alok Chandra Agrawal ◽

Sharath Kowshik

Keyword(s):

Distal Femur ◽

Femur Fracture ◽

Poor Quality ◽

Implant Failure ◽

Geriatric Population ◽

Early Ambulation ◽

Non Union ◽

Distal Femur Replacement ◽

Knee Society Function Score

Introduction: Incidence of non-union of fracture involving the supracondylar region of femur in an elderly is increasing due to bone loss from trauma and availability of poor quality bone in geriatric population. Distal femur megaprosthesis can provide a single stage solution for resistant non-union of supracondylar femur. Case Report: We are reporting two cases of non-union of supracondylar femur with implant failure treated with distal femoral tumor megaprosthesis. We achieved excellent improvement of the Knee Society Score from 15 to 75; Knee Society Function Score from 0 to 60, good range of motion, and pain free ambulation without support at 3 months follow-up. Conclusion: Management of non-union of supracondylar femur with implant failure is challenging task. Distal femur replacement using tumor megaprosthesis is useful option for such resistant cases in achieving early ambulation and overall good functional outcome. Keywords: Non-union, distal femur fracture, megaprosthesis, supracondylar femur fracture.

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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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Reverse distal femoral locking plate for subtrochanter femur fracture

Medical Journal of Indonesia ◽

10.13181/mji.v27i2.1377 ◽

2018 ◽

Vol 27 (2) ◽

Author(s):

Peter Giarso ◽

Ismail H. Dilogo

Keyword(s):

Distal Femur ◽

Locking Plate ◽

Femur Fracture ◽

Case Series ◽

Subtrochanteric Fracture ◽

Locking Compression Plate ◽

Non Union ◽

Functional Scores ◽

The Right ◽

Subtrochanteric Femur Fracture

In these case series, we used titanium locking compression plate-distal femur (LCP-DF) plate (Synthes) 9–11 hole using less invasive stabilization system or open reduction technique. This case series aims to determine the functional scores on reverse distal femoral locking plate for subtrochanteric femur fracture. A 34-year-old male with closed subtrochanteric fracture of the right femur (Seinsheimer 2B) with Harris hip scores (HHS) of 17, 96, and 97 obtained consecutively in 0, 6, and 12 months, respectively. A 24-year-old male with closed comminuted subtrochanteric fracture of the right femur (Seinsheimer V) with HHS of 13, 93, and 97 at 0, 6, and 12 months respectively. A 39-year-old male with non-union, left subtrochanteric femur fracture (Seinsheimer 2C) yielded HHS of 38, 73, and 77 at 0, 6, and 12 months, respectively. A 35-year-old female with close subtrochanteric fracture of the right femur (Seinsheimer IIB) yielded HHS of 23, 40, and 73 at 0, 6, and 12 months, respectively. Mean initial HHS and scores at 6 and 12 months reached 22, 75, and 86, respectively.

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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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A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212438 ◽

2021 ◽

Vol 7 (4) ◽

pp. 864

Author(s):

Neetin P. Mahajan ◽

Pranay Kondewar ◽

Lalkar Gadod ◽

Amey Sadar ◽

Shubham Atal

Keyword(s):

Clinical Outcome ◽

Bone Grafting ◽

Femur Fracture ◽

Good Clinical Outcome ◽

Non Union ◽

Autologous Bone Grafting ◽

Exchange Nailing ◽

Autologous Bone ◽

Subtrochanteric Femur Fracture

<p class="abstract">Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.</p>

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Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates

International Surgery Journal ◽

10.18203/2349-2902.isj20202833 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2261

Author(s):

Rohil Singh Kakkar ◽

Deepak Mehta ◽

Ankit Sisodia

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Radiological Assessment ◽

Fracture Union ◽

Contact Loading ◽

Non Union ◽

Locking Compression Plates ◽

Clavicle Fractures

Background: Fractures of the clavicle constitute approximately 2.6% of all the fractures and nearly 44-66% of fractures around shoulder.Methods: This particular study is intended to assess the functional and radiological outcomes in a series of 32 patients with closed displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured clavicle locking compression plates.Results: All 32 patients achieved fracture union within 6 months follow up period. As per Constant-Murley scoring, 56.25% cases had excellent results, 34.37% cases had good, 6.25% cases had fair and 3.12% of the cases had poor results respectively.Conclusions: Open reduction and internal fixation surgery with pre-contoured locking compression plates in the displaced midshaft clavicle fractures restores the anatomy, biomechanics and contact loading characteristics of the clavicle and significantly reduces the incidence of non-union with improved functional outcomes resulting in better patient satisfaction.

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Use of Tantalum Trabecular Metal Cones for Management of Nonunion of the Distal Femur with Segmental Bone Defects: Technique and Case Series

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i07.2298 ◽

2021 ◽

Vol 11 (7) ◽

Author(s):

Alan W Reynolds ◽

Patricia R Melvin ◽

Eric J Yakish ◽

Nicholas Sotereanos ◽

Gregory T Altman ◽

...

Keyword(s):

Distal Femur ◽

Case Series ◽

Bone Defects ◽

Autologous Bone Graft ◽

Trabecular Metal ◽

Non Union ◽

Segmental Bone ◽

Keywords Femur ◽

Segmental Bone Defects

Introduction: Segmental bone loss in the distal femur presents a challenge for reconstruction regardless of etiology. Use of tantalum trabecular metal cones with intramedullary fixation and autologous bone graft may be used as a salvage technique in difficult situations where other options have either been exhausted or are unavailable. Case Report: Surgical planning and technique for this approach to reconstruction are described. A retrospective review of five cases with >1 year of follow-up was performed to provide radiographic and clinical outcomes. All five patients had satisfactory outcomes with clinical union and retention of implants at final follow-up (average >4 years). Conclusions: Use of tantalum metal cones for reconstruction of distal femur nonunion with segmental bone defects can be a successful technique in a complex group of patients. Keywords: Femur, bone defect, non-union, induced membrane, tantalum.

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EVALUATION OF RESULTS OF DISTAL FEMUR LOCKING PLATE IN DISTAL FEMUR FRACTURES

10.36106/ijsr/6305838 ◽

2021 ◽

pp. 9-12

Author(s):

Hemeshwar Harshwardhan ◽

Sumit Raj

Keyword(s):

Functional Outcomes ◽

Distal Femur ◽

Locking Plate ◽

Femur Fracture ◽

Randomized Study ◽

Knee Score ◽

Entire Study ◽

Medical College ◽

Femur Fractures ◽

Classi Cation

Background: The choice of distal femur locking plate in distal femur fractures has been a topic of debate. This study was performed to evaluate the results of distal femur locking plate in distal femur fractures. A prospective Material and Methods : randomized study of 30 patients with distal femur fracture was conducted at Department of Orthopaedics, JLN Medical College, Ajmer from January 2019 to July 2020 and followed up from 6 months to 18 months for a minimum of 6 months duration. The distal femur locking compres Implants used : sion plate. Classification system : AO Classication. Clinical and functional outcomes were assessed using Ra Results & Observations : smussen's functional knee score. Complications of fractures and operative treatment were assessed. The results of entire study group showed 18 excellent, 10 good, 1 fair and 1 poor. Conclusion : We observed and recommend that the distal femur LCP is an optimal tool of good xation for fractures of distal femur.

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The use of Tightrope device as the sole method of fixation in treating lateral end clavicle fractures

Shoulder & Elbow ◽

10.1177/1758573220964807 ◽

2020 ◽

pp. 175857322096480

Author(s):

K Al-Tawil ◽

M Garner ◽

T Antonios ◽

K Karrupaiah ◽

R Tahmassebi ◽

...

Keyword(s):

Functional Outcomes ◽

Good Method ◽

Objective Measures ◽

Non Union ◽

Oxford Shoulder Score ◽

Secondary Procedures ◽

Clavicle Fractures ◽

Male Patients ◽

Shoulder Score

Background Lateral end clavicle fractures can be challenging due to the small and often comminuted lateral fragment, problems with union and stability and implant morbidity. We retrospectively reviewed outcomes of Tightrope device in isolation to treat lateral end clavicle fractures. Methods Subjective and objective measures were assessed for 29 patients. The subjective comprised of functional clinical scores: Oxford shoulder score and EuroQoL5D. The objective measures were maintenance of fracture reduction, bone healing and complications. Results Median age was 36 years and 72% of cases were male patients. Average clinical follow up time was 21 months. Evaluation of latest radiographs showed that all reductions were maintained post-operatively. Twenty-two fractures had united and one patient had established non-union. Functional outcomes showed predominantly good results with Oxford shoulder score average of 41, EuroQoL5D index score of 0.78 and EuroQol Visual Analogue Scale 76. The overall post-operative complication rate was 10%; only one case requiring a secondary procedure. Discussion In our series, using the Tightrope as the sole device to treat displaced lateral end of clavicle fractures resulted in good radiological and functional outcomes, with minimal complications requiring secondary procedures. We believe the Tightrope device is a good method of fixing these challenging fractures and advocate its use.

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Knee arthroplasty with hardware removal: complication cascade. Is it preventable?

BMJ Case Reports ◽

10.1136/bcr-2019-233700 ◽

2020 ◽

Vol 13 (8) ◽

pp. e233700

Author(s):

Gabriel Nierenberg ◽

Alaa Abu Elasal ◽

Eran Keltz ◽

Doron Norman

Keyword(s):

Distal Femur ◽

Femur Fracture ◽

Total Joint Replacement ◽

Plate Fixation ◽

Open Reduction Internal Fixation ◽

Hardware Removal ◽

Fixation Device ◽

Temporary Reduction ◽

Non Union ◽

Total Knee

An elderly woman underwent hardware removal and total joint replacement (TJR) of her right knee. Ipsilateral total tip replacement was performed 7 years earlier, and 12 months later, a supracondylar fracture of the index femur was successfully treated by open reduction internal fixation (ORIF) of the distal femur with a locking compression plate condylar plate. Hardware removal attempt, prior to the arthroplasty, resulted in fracture of the distal femur. Total knee replacement (TKR) was commenced with temporary reduction and final stabilisation of the femur fracture with a condylar plate. Postoperatively, non-union of the femur fracture developed twice with fatigue failure of the plate fixation device in both instances. Refixation of the femur was performed on both occasions and additional bone healing augmentation measures were performed for each subsequent surgery. Femur union was achieved fourteen months after the last surgery.

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