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

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.

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