Proximal And Distal Femur Replacement For Patient With Non Union Fracture Of Intertrochanteric And Supracondylar Of Femur In A District Hospital

Introduction: Non-union of intertrochanteric and supracondylar fractures of femur are uncommon which results in pain and functional disability, presenting major surgical challenge. We wish to report on two cases regarding endoprosthesis as management for non-union. Case Presentation: Patient A is 54 years old lady sustained closed comminuted intertochanteric fracture of right femur (31A2.3). She underwent open reduction, intramedullary nail with cerclage wire on day 3 post trauma. At 6 months, there is sign of avascular necrosis of femur head with non-union fracture site. Patient still complaining of pain, on non-weight bearing ambulation. At 1 year, patient underwent right proximal femur replacement. At 3 months post replacement, she is able to full weight bear with walking cane without pain. Patient B is 56 years old gentleman sustained Grade IIIa open comminuted fracture of right supracondylar with intercondylar split (33C2.2). He underwent emergency wound debridement, screw fixation with high tibial pin insertion. At 4 months, he underwent distal locking plate of right femur with synthetic bone grafting. At 8 months post fixation, there is non-union comminuted fracture of supracondylar, still unable to weight bear. At 1.5 year post trauma, patient underwent right distal femur replacement. At 3 weeks post replacement, he is able to full weight bear without aid. Discussion: Most failures of treatment occur in unstable fracture patterns of hip. (1) Endoprosthesis may provide as alternative treatment if internal fixation are recognized to be suboptimal, amount and quality of remaining distal bone stock and level of the non-union. (2,3) In both our cases, patient experienced marked improvement in functional capacity and pain free, which are the hallmarks of a successful salvage procedure. (4) Conclusion: Endoprosthesis can be consider as alternative treatment for non-union intertrochanteric and supracondylar fracture of femur, hence providing stable joint, pain free and early return to daily activities. References: 1) Dhammi, I., Singh, A., Mishra, P., Jain, A., Rehan-Ul-Haq, & Jain, S. (2011). Primary nonunion of intertrochanteric fractures of femur: Analysis of results of valgization and bone grafting. Indian Journal of Orthopaedics, 45(6), 514.doi:10.4103/0019-5413.87122 2) Outcomes of modular proximal femoral replacement in thetreatment of complex proximal femoral fractures: A caseseries: Andrew J. Schoenfeld, Mark C. Leeson, Gregory A. Vrabec, Joseph Scaglione,Matthew J. Stonestreet. International journal of surgery 6 (2008) 140–146 3) Chapman MW. Nonunions and malunions of the femoral shaft and patella. In: Chapman MW, editor. Operative orthopedics. 2nd ed. Philadelphia: J.B. Lippincott; 1993. p. 841 4) Haidukewych, G. J., Springer, B. D., Jacofsky, D. J., & Berry, D. J. (2005). Total KneeArthroplasty for Salvage of Failed Internal Fixation or Nonunion of the Distal Femur. The Journal of Arthroplasty, 20(3), 344–349. doi:10.1016/j.arth.2004.03.026

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Repeat Russe Bone Grafting after Failed Bone Graft Surgery for Scaphoid Non-Union

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80096-8 ◽

1995 ◽

Vol 20 (3) ◽

pp. 373-378 ◽

Cited By ~ 10

Author(s):

E. B. BYNUM ◽

R. W. CULP ◽

T. J. BONATUS ◽

C. E. ALEXANDER ◽

H. R. McCARROLL

Keyword(s):

Internal Fixation ◽

Bone Grafting ◽

Surgical Procedure ◽

Full Employment ◽

Salvage Procedure ◽

Term Outcome ◽

Long Term Outcome ◽

Non Union ◽

Low Rate

We report the long-term outcome of repeat Russe bone grafting after failure of a previous Russe graft for scaphoid non-union. 15 patients were followed for a mean of 71 months after their last surgical procedure. 11 patients had undergone a single previous Russe graft and four patients had two previous graft attempts. Internal fixation was used in only three patients. Eight out of 15 (53%) patients achieved union after a single repeat graft and one out of four united after a third attempt. When union was achieved, range of motion was unchanged, grip strength was increased 10%, and pain was slight to none, allowing return to full employment in seven out of the nine patients. All patients who did not achieve union have either undergone a salvage procedure or are contemplating one. Based on the literature and our relatively low rate of union without internal fixation (53%), we recommend supplementary internal fixation if repeat Russe bone grafting is undertaken. When union is achieved, satisfactory results can be expected.

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The Outcome of Using a Jamshidi Biopsy Trocar Needle in a Novel Technique for Bone Grafting in Percutaneous Internal Fixation of Scaphoid Non-Union

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.139 ◽

2018 ◽

Vol 6 (3) ◽

pp. 506-510

Author(s):

Syed Bokhari ◽

Saifullah Hadi ◽

Fahad Hossain ◽

Bernd Ketzer

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Bone Grafting ◽

Proximal Pole ◽

Union Rate ◽

Non Union ◽

Novel Technique ◽

Grafting Technique ◽

Percutaneous Internal Fixation ◽

Time From Injury

INTRODUCTION: We report the outcome of using a novel technique of minimally invasive internal fixation and distal radius bone grafting using the Jamishidi Trephine needle and biopsy/graft capture device.METHODS: The technique utilises a 8 mm incision at the distal pole of the scaphoid. The non-union is excavated using the standard Acutrak drill. An 8 gauge Jamshidi trephine needle is used to harvest bone graft from the distal radius which is impacted into the scaphoid and fixed with an Acutrak screw. Fifteen patients were available for retrospective review, 14 male, age mean 29.5 (15-56). Average time from injury to surgery was 167 days (45-72). Fractures classified according to Herbert giving 7 D1 and 8 D2 fractures, 14 waist and 1 proximal pole fractures, all of which had no humpback deformity.RESULTS: Sixty-six percentages of the fractures went onto unite, 4/7 D1 and 6/8 D2 united (p > 0.05). Seventy-five percentages of fracture that had surgery in less than 3 months from time of injury went onto unite, whereas only 63% united in patients who had surgery later than 3 months (p > 0.05). DASH outcome for all patients improved from 86 down to 32 (p < 0.05). With those that united going down from 90 to 6. Those that did not unite went from 81 to 61.CONCLUSION: The Jamshidi bone grafting technique shows comparable results (union rate 66%) to other techniques published in the literature (27-100%) providing the surgeon with an alternative and less demanding procedure than open scaphoid non-union surgery.

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A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

10.25259/jassm_28_2020 ◽

2020 ◽

Vol 0 ◽

pp. 1-4

Author(s):

Syed Shumon ◽

Moin Durrani ◽

Karthikeyan P. Iyengar ◽

William Y. C. Loh

Keyword(s):

Conservative Treatment ◽

Internal Fixation ◽

Bone Grafting ◽

Scaphoid Fracture ◽

Carpal Bone ◽

Non Union ◽

Scaphoid Fractures ◽

First Case ◽

Vascularized Bone ◽

Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

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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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DISI DEFORMITY AND POST-OPERATIVE SYMPTOMS OF SCAPHOID NON-UNION

Hand Surgery ◽

10.1142/s0218810499000393 ◽

1999 ◽

Vol 04 (02) ◽

pp. 117-124 ◽

Cited By ~ 3

Author(s):

T. Wada ◽

M. Aoki ◽

M. Usui ◽

S. Ishii

Keyword(s):

Internal Fixation ◽

Grip Strength ◽

Bone Grafting ◽

Open Reduction ◽

Average Duration ◽

Bone Screw ◽

Non Union ◽

Significant Difference ◽

Corticocancellous Bone Grafting

The correlation between the residual dorsal intercalated segmental instability (DISI) deformity and symptoms of the wrist was investigated in 20 patients with healed scaphoid non-union who had open reduction and bone grafting. In seven patients, inlay corticocancellous bone grafting (modified Russe procedure) was performed. In four of the seven patients, an additional Herbert bone screw was used for internal fixation. The remaining 13 patients were treated with open reduction, anterior bone grafting, and internal fixation with Herbert bone screw. Average duration of follow-up period after operation was 20 months (range, 6 to 57 months). The average extension-flexion arc of the injured wrists was 129°, which was 31° less than that of the uninjured wrists. The average grip strength of the injured wrists was 89% of that of the uninjured wrist. Before the operation, all 20 patients were symptomatic and complained of wrist pains. Post-operatively, three patients experienced mild pains and only one complained of moderate wrist pains. Post-operative radiolunate angle ranged from 0° to 34° (average 10°). DISI deformity remained uncorrected in eight patients. Post-operative symptoms were compared amongst the eight patients who had DISI deformity and 12 patients who had no deformity. There was no significant difference in range of motion, grip strength, and incidence of pain between these two groups of patients. The presence of DISI deformity after bone grafting for a symptomatic scaphoid non-union was not predictive of post-operative symptoms of the wrist.

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Distal Femur Replacement versus Open Reduction and Internal Fixation for Treatment of Periprosthetic Distal Femur Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002141 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Harsh Wadhwa ◽

Brett P. Salazar ◽

L. Henry Goodnough ◽

Noelle L Van Rysselberghe ◽

Malcolm R. DeBaun ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Femur ◽

Femur Fractures ◽

Distal Femur Replacement

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Quadriceps-splitting midline approach in the treatment of distal femur infected nonuinon with stiff knee and severely scarred soft tissues

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200572 ◽

2020 ◽

Vol 6 (2) ◽

pp. 276

Author(s):

Jeremy Bliss ◽

Dan Barnabas Inja ◽

Manasseh Nithyananth ◽

Vinoo Mathew Cherian

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Soft Tissues ◽

Distal Femur ◽

Bony Union ◽

Infected Nonunion ◽

Non Union ◽

Knee Stiffness ◽

Iliac Crest Bone Grafting ◽

Stiff Knee

Background: Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.Methods: We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.Results: 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant in situ. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.Conclusions: In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover.

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Results of internal fixation and anterior muscle pedicle bone grafting in old femoral neck fracture

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v43i1-2.13016 ◽

2012 ◽

Vol 43 (1-2) ◽

pp. 10-11 ◽

Cited By ~ 1

Author(s):

MI Khalil ◽

A Rahman

Keyword(s):

Internal Fixation ◽

Bone Grafting ◽

Rectus Femoris ◽

Fracture Site ◽

Easy Access ◽

Bone Block ◽

Range Of Movement ◽

College Hospital ◽

Non Union ◽

Fracture Neck Femur

Sixteen cases of old fracture neck femur were treated by internal fixation and anterior muscle pedicle bone grafting of rectus femoris, sartorius bone block from anterior superior iliac spine. The treatment period were from January 2000 to December 2009 at Khulna Medical College Hospital and some private hospital. Different methods of fixation and bone grafting procedure were reported. We did this procedure by open reduction and internal fixation by cannulated hip screws and muscle pedicle bone grafting. Additional cancellous bone grafting were done in every cases. Follow up period was 2 to 7 years (average 5 years). Evaluation parameter were union, non union. collapse of neck, avascular necrosis of femoral head (AVN) coxavara, shortening, pain, range of movement and functional activities and over all satisfaction of patient. The results of fracture healing rate was good (9), fair (4) and poor (3). The technique is simple, rewarding and easy access of fixation and muscle pedicle bone grafting. Bone graft was placed by making a gutter at fracture site and maintained by a screw or prolin suture. DOI: http://dx.doi.org/10.3329/bmjk.v43i1-2.13016 Bang Med J (Khulna) 2010; 43: 10-11

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MID-SHAFT CLAVICLE FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.06.1734 ◽

2013 ◽

Vol 20 (06) ◽

pp. 1006-1009

Author(s):

KASHIF KHURSHID QURESHI ◽

ZULFIQAR AHMED ◽

IMRAN ASIF BAJWA ◽

Saeed Ahmed ◽

Hassan Moin

Keyword(s):

Internal Fixation ◽

Medical Record ◽

Bone Grafting ◽

Open Reduction ◽

Sports Injury ◽

Non Union ◽

Small Series ◽

Clavicle Fractures ◽

Operative Fixation ◽

Grafting Procedure

Objectives: To study the time to union and complications after open reduction and internal fixation of mid-shaft claviclefractures. Design: Retrospective. Settings: Midlands Orthopedic/ Sports Injury Clinic, Bahawalpur. Study Period: 2003 to December2012. Material and Methods: The medical record of the patients operated for mid-shaft clavicle fractures was searched to find out thetime to union and occurrence of complications during this period. Results: The time to union was 4.6 months and there were twocomplications. A prominent implant had to be removed and one non-union required additional bone grafting procedure. Conclusions:This small series shows that the rate of complications is low and a larger study is needed to expand the indications for operative fixation ofclavicle fracture safely.

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Functional and radiological outcome following operative skeletal stabilisation with bone grafting in distal femur non-unions: a study of 21 patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170435 ◽

2017 ◽

Vol 3 (2) ◽

pp. 150

Author(s):

Navin Balasubramanian ◽

Sindhuja P.

Keyword(s):

Bone Grafting ◽

Distal Femur ◽

Open Reduction Internal Fixation ◽

Radiological Outcome ◽

Type B ◽

Postoperative Rehabilitation ◽

Non Union ◽

Native Bone ◽

Type C

Background: The study was done to assess the functional and radiological outcome after operative skeletal stabilisation with bone grafting in 21 patients who presented to us with distal femur non-unions.Methods: Between August 2008 and October 2015, 21 patients (M:F- 14:7) with established non-unions of the distal femur were included. All patients presented to us with established non-union following treatment with a native bone setter using splints. There were 16 patients with AO Type A, 4 with AO Type B and one patient with Type C. All patients underwent open reduction, internal fixation with plate and screws and bone grafting. Serial follow-ups were done at 4, 8, 12, 16, 20, 24 weeks and 6 monthly thereafter.Results: All 21 patients had complete fracture healing at average of 19 weeks (Range 16-24). Knee flexion (ROM) improved from an average 16® pre-op to 66® post-operatively. There were no implant failure, infection or non-unions in our study. The Knee Society score improved from 54 pre-operatively to 74 post-operatively at last follow-up. Conclusions: Even in established non-unions, good results can be expected if good surgical technique is followed and with bone grafting satisfactory union rated can be achieved. Knee ROM also improves with dedicated postoperative rehabilitation.

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