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Two-stage surgical treatment for non-union of a shortened osteoporotic femur.

Said GZ, Farouk OA, Said HG - Trauma Mon (2013)

Bottom Line: In stage I, the femoral non-union was treated by open reduction, internal fixation and iliac bone grafting.Three years later he reported that he was satisfied with the result of treatment and was leading a normal life as a university student.It has also succeeded in reducing the treatment time of the external fixator.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.

ABSTRACT

Introduction: We report a case of non-union with severe shortening of the femur following diaphysectomy for chronic osteomyelitis.

Case presentation: A boy, aged 16 years presented with a dangling and excessively short left lower limb. He was using an elbow crutch in his right hand to help him walk. He had a history of diaphysectomy for chronic osteomyelitis at the age of 9. Examination revealed a freely mobile non-union of the left femur. The femur was the seat of an 18 cm shortening and a 4 cm defect at the non-union site; the knee joint was ankylosed in extension. The tibia and fibula were 10 cm short. Considering the extensive shortening in the femur and tibia in addition to osteoporosis, he was treated in two stages. In stage I, the femoral non-union was treated by open reduction, internal fixation and iliac bone grafting. The patient was then allowed to walk with full weight bearing in an extension brace for 7 months. In Stage II, equalization of leg length discrepancy (LLD) was achieved by simultaneous distraction of the femur and tibia by unilateral frames. At the 6 month follow- up, he was fully weight bearing without any walking aid, with a heel lift to compensate the 1.5 cm shortening. Three years later he reported that he was satisfied with the result of treatment and was leading a normal life as a university student.

Conclusions: Two-stage treatment succeeded to restore about 20 cm of the femoral shortening in a severely osteoporotic bone. It has also succeeded in reducing the treatment time of the external fixator.

No MeSH data available.


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Anterior-posterior View After 7 Months of Weight Bearing in the Extension Brace, Showing Improved Bone Quality
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fig3026: Anterior-posterior View After 7 Months of Weight Bearing in the Extension Brace, Showing Improved Bone Quality

Mentions: It was judged that the bones would not withstand any distraction for lengthening, thus surgery was done in two stages. In stage I, open reduction, condylar plate fixation and iliac bone grafting of the femoral for treatment of atrophic non-union were done (Figure 2). During surgery the muscles were found to have converted in to fibrous tissue. Approximation of the bone ends resulted in the addition of 4 cm to the pre-existing femoral shortening. Healing of the non-union in the shortened position was achieved in 8 weeks. The patient was then fitted with an extension brace with a shelf under the foot fixed to the sidebars for weight bearing (Figure 3). The patient was allowed to walk with a full weight bearing in a brace for the following 7 months to improve the bone quality (Figure 4). In stage II a simultaneous femoral and tibial distraction lengthening using unilateral frames was done (Figures 5 and 6). To avoid migration of the lengthening Schanz screws in the distal femur, we inserted the screws of the unilateral frame through the holes of the plate. This was done after exchanging the condylar plate with a shorter one and the osteotomy was done above the upper end of the plate. In the end, a 21.3 cm femoral lengthening (47% lengthening ratio) was achieved (Figure 7). Due to the severe osteoporosis of the leg bones, tibial osteotomy was performed in the diaphysis to allow insertion of 3 Schanz screws in the proximal tibia. The distraction time was 7 months and the distraction device was removed 3 months later. The patient was provided with a brace to protect the regenerate, as he was eager to go back to his country. During lengthening of the leg bones he developed equinus deformity and bowing of the leg. Both complications were corrected surgically. No vascular, neurological or soft tissue complications were encountered during the extensive distraction lengthening. At the 6-month follow-up, he was fully weight bearing without any walking aid and had a heel lift to compensate the 1.5 cm shortening, although with a stiff knee. His quality of life as measured by SF-36v2 PCS has increased to 57.7 and MCS to 54.6. Three years later he reported that he was leading a normal life as a university student, was satisfied with the results of treatment and he was requesting a mobile knee.


Two-stage surgical treatment for non-union of a shortened osteoporotic femur.

Said GZ, Farouk OA, Said HG - Trauma Mon (2013)

Anterior-posterior View After 7 Months of Weight Bearing in the Extension Brace, Showing Improved Bone Quality
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860648&req=5

fig3026: Anterior-posterior View After 7 Months of Weight Bearing in the Extension Brace, Showing Improved Bone Quality
Mentions: It was judged that the bones would not withstand any distraction for lengthening, thus surgery was done in two stages. In stage I, open reduction, condylar plate fixation and iliac bone grafting of the femoral for treatment of atrophic non-union were done (Figure 2). During surgery the muscles were found to have converted in to fibrous tissue. Approximation of the bone ends resulted in the addition of 4 cm to the pre-existing femoral shortening. Healing of the non-union in the shortened position was achieved in 8 weeks. The patient was then fitted with an extension brace with a shelf under the foot fixed to the sidebars for weight bearing (Figure 3). The patient was allowed to walk with a full weight bearing in a brace for the following 7 months to improve the bone quality (Figure 4). In stage II a simultaneous femoral and tibial distraction lengthening using unilateral frames was done (Figures 5 and 6). To avoid migration of the lengthening Schanz screws in the distal femur, we inserted the screws of the unilateral frame through the holes of the plate. This was done after exchanging the condylar plate with a shorter one and the osteotomy was done above the upper end of the plate. In the end, a 21.3 cm femoral lengthening (47% lengthening ratio) was achieved (Figure 7). Due to the severe osteoporosis of the leg bones, tibial osteotomy was performed in the diaphysis to allow insertion of 3 Schanz screws in the proximal tibia. The distraction time was 7 months and the distraction device was removed 3 months later. The patient was provided with a brace to protect the regenerate, as he was eager to go back to his country. During lengthening of the leg bones he developed equinus deformity and bowing of the leg. Both complications were corrected surgically. No vascular, neurological or soft tissue complications were encountered during the extensive distraction lengthening. At the 6-month follow-up, he was fully weight bearing without any walking aid and had a heel lift to compensate the 1.5 cm shortening, although with a stiff knee. His quality of life as measured by SF-36v2 PCS has increased to 57.7 and MCS to 54.6. Three years later he reported that he was leading a normal life as a university student, was satisfied with the results of treatment and he was requesting a mobile knee.

Bottom Line: In stage I, the femoral non-union was treated by open reduction, internal fixation and iliac bone grafting.Three years later he reported that he was satisfied with the result of treatment and was leading a normal life as a university student.It has also succeeded in reducing the treatment time of the external fixator.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.

ABSTRACT

Introduction: We report a case of non-union with severe shortening of the femur following diaphysectomy for chronic osteomyelitis.

Case presentation: A boy, aged 16 years presented with a dangling and excessively short left lower limb. He was using an elbow crutch in his right hand to help him walk. He had a history of diaphysectomy for chronic osteomyelitis at the age of 9. Examination revealed a freely mobile non-union of the left femur. The femur was the seat of an 18 cm shortening and a 4 cm defect at the non-union site; the knee joint was ankylosed in extension. The tibia and fibula were 10 cm short. Considering the extensive shortening in the femur and tibia in addition to osteoporosis, he was treated in two stages. In stage I, the femoral non-union was treated by open reduction, internal fixation and iliac bone grafting. The patient was then allowed to walk with full weight bearing in an extension brace for 7 months. In Stage II, equalization of leg length discrepancy (LLD) was achieved by simultaneous distraction of the femur and tibia by unilateral frames. At the 6 month follow- up, he was fully weight bearing without any walking aid, with a heel lift to compensate the 1.5 cm shortening. Three years later he reported that he was satisfied with the result of treatment and was leading a normal life as a university student.

Conclusions: Two-stage treatment succeeded to restore about 20 cm of the femoral shortening in a severely osteoporotic bone. It has also succeeded in reducing the treatment time of the external fixator.

No MeSH data available.


Related in: MedlinePlus