Reconstruction of Juxta-Articular Bone Defect in an Infected Fracture Distal Right Femur Using Autologous Fibular Strut and Iliac Crest Graft

Distal femur fractures are about 7 % of all femur fractures.1 Being complex in nature management of these fractures is difficult; management is still a challenge in this technically advanced era. Fibular strut graft is one of the useful and simple options to manage defects in distal femur fractures. High velocity injuries causing open fractures may lead to infection and non-union of fracture if proper debridement and antibiotics are not used as per established protocol. Antibiotics can be given mixed with polymethyl-methacrylate (PMMA) cement formed in beads at the open fracture site or coated over a nail.2 This causes slow release of antibiotics and helps in control of infection. Local infection, damaged soft tissue, ischemia over fracture site, stabilisation of fracture, the hardware used and patient’s co morbidities all play a role in union and infection control of open fractures. Early detection of infection is important to avoid non-union and related complications. Distal femur juxta-articular fracture may develop infection due to fractures and unstable fixation more commonly. This may result in cavity formation and complications like osteomyelitis often leading to bone destruction and sequestrum formation. Its management becomes a challenging task for an orthopaedic surgeon.3- 9 The reconstructive methods are autogenous cortical bone, cancellous bone, allograft, bone substitutes like synthetic bone blocks and bone granules. Free bone transfer is crucial in reconstructing massive defects in distal femur fracture due to properties of rapid healing and being hypertrophic.7-13 Fibula is the best available option for grafting in massive defects of femur due to its characteristics like mechanical strength, length, minimum morbidity, and resistance to infection.3,11,13 A single fibula strut graft can give up to 26 cm of graft. The case reported here is of a patient of juxta-articular bone defect in an infected previously operated fracture distal femur using autologous fibular strut and iliac crest graft

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Autologous Fibular Strut Graft as a Substitute for Iliac Crest Graft and Bone Substitutes or Implant in Opening Wedge Valgus Tibia Osteotomy in Children

World Journal of Innovative Research ◽

10.31871/wjir.6.5.17 ◽

2019 ◽

Vol 6 (5) ◽

Author(s):

Nwachukwu AC ◽

Nwachukwu CC

Keyword(s):

Iliac Crest ◽

Bone Substitutes ◽

Opening Wedge ◽

Iliac Crest Graft ◽

Strut Graft ◽

Tibia Osteotomy ◽

Fibular Strut

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Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i1.27073 ◽

2019 ◽

Vol 6 (1) ◽

pp. 25-30

Author(s):

Rajendra Sanjel Chhetri ◽

Kishor Prashad Khatri ◽

Krishna Kharel

Keyword(s):

Avascular Necrosis ◽

Delayed Union ◽

Harris Hip Score ◽

Outcome Analysis ◽

Fracture Union ◽

Neck Of Femur ◽

Strut Graft ◽

Non Union ◽

Fracture Neck Of Femur ◽

Fibular Strut

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur. Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS). Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%). Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

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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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Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.03.018 ◽

2020 ◽

Vol 73 (7) ◽

pp. 1232-1238

Author(s):

Charlotte Jaloux ◽

Quentin Bettex ◽

Michel Levadoux ◽

Alexandre Cerlier ◽

Aurélie Iniesta ◽

...

Keyword(s):

Iliac Crest ◽

Femoral Condyle ◽

Medial Femoral Condyle ◽

Iliac Crest Graft ◽

Non Union

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Assessment of radiological outcomes in gap non-union of long bones using non-vascularised fibular strut graft augmented with corticocancellous graft

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i3a.10 ◽

2018 ◽

Vol 4 (3.1) ◽

pp. 43-46

Author(s):

Rajendraprasad Butala ◽

Abdul Malik Nagori ◽

Vinit Vimal Karn ◽

Prakash Samant

Keyword(s):

Long Bones ◽

Strut Graft ◽

Non Union ◽

Fibular Strut

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Prospective Evaluation of Role of Limb Reconstruction System (Rail External Fixator) in Open Fractures and Infected Non-union of Femur

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i01.1942 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hemant Singh Chahar ◽

Mayur Gupta ◽

Vinod Kumar ◽

Rohit Yadav ◽

Jaydeep Patel ◽

...

Keyword(s):

Tissue Injury ◽

Soft Tissue Injury ◽

Case Series ◽

Functional Results ◽

Open Fractures ◽

Long Bone ◽

Limb Reconstruction ◽

Non Union ◽

Femur Fractures

Introduction: Severe open fractures continue to be a nightmare for orthopedicians even with use of more accepted line of treatment. Open fractures and infected non-union of femur bone are not infrequently seen in orthopedic wards as femur is the most common long bone injured. We present a case series of 14 such patients treated successfully with limb reconstruction system enabling recovery to pre-injury status and activities. Case Series: The present study was done to access the role of limb reconstruction system in the management of open femur fractures and in infected non-union with modifications to meet the requirements of each case. We viewed the results of treatment of 14 cases of late presentation with complicated open femur fractures and infected non-unions. Average time of fixator removal was 4 months–24 months. Average follow-up duration was 18 months (range 6?36 months). Evaluation of results was based on ASAMI criteria. The excellent bone results were obtained in 85.72% of cases while 7.14% showed good and 7.14% were poor results. Excellent functional results were observed in 71.43% of cases and 28.57% of cases shows good and fair results. Conclusion: The use of limb reconstruction system is based on compression and distraction technique. It was found to be a simple and effective modality for open injuries in terms of enhanced union rate, rapid rehabilitation, and easy care of soft-tissue injury along with bone loss, thus avoiding multiple surgeries. Keywords: Open fracture, non-union, femur, limb reconstruction system, ASAMI criteria.

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Shaft of humerus non-union: operated with fibular strut graft and long PHILOS

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2021.v7.i4b.2872 ◽

2021 ◽

Vol 7 (4) ◽

pp. 112-113

Author(s):

Dr. Vishal Haldar ◽

Dr. Aditya Kumar Mishra ◽

Dr. Mohd. Bilal Kaleem ◽

Dr. Navneet Badoni ◽

Dr. Anshul Sethi ◽

...

Keyword(s):

Strut Graft ◽

Non Union ◽

Fibular Strut

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A Systematic Review On The Outcomes Of Fibular Strut Graft For Femoral Neck Fractures In Adults

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v4i1.26912 ◽

2021 ◽

Vol 4 (1) ◽

pp. 66

Author(s):

Bintang Soetjahjo ◽

Udi Heru Nefihancoro ◽

Rieva Ermawan ◽

Gilang Teguh Pratama

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

High Energy ◽

Femoral Neck Fractures ◽

Cochrane Library ◽

Bony Union ◽

Scientific Publications ◽

Strut Graft ◽

Non Union ◽

Fibular Strut

Introduction: Femoral neck fractures are a type of intracapsular hip fracture which also be found in younger patients who suffered from high-energy trauma such as vehicle accidents. Non-union and avascular necrosis are the most frequent complications following femoral neck fractures. In this study, we reviewed the outcomes of fibular grafting techniques for femoral neck fractures in adults.Method: Online libraries PubMed, Cochrane Library and Scopus were searched for relevant papers. We searched for scientific publications published between 2009 and 2020. Inclusion and exclusion criteria were used, and prespecified characteristic were extracted from each study.Result: We found 172 papers relevant to the topic. At last, we included 6 papers in this systematic review with a total of 198 patients. Fibular strut graft for femoral neck fractures have shown excellent outcomes, uniting 177 (89,39%) of 198 fractures reviewed. Overall, 15 patients (7,57%) experiencing non-union and 12 patients (6,06%) having avascular necrosis.Conclusion: The outcomes of the intervention turned out to be excellent, assessed by both functional outcome criteria and radiographic bony union. It is important to established a consensus on surgical intervention for femoral neck fractures, specifically including fibular strut grafting.

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