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May 8, 2007, 1:06 AM
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Re: [ORT-L] [Orthopod] Fwd: [Ortho] The patient with non-union of the
distal ...
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Dear all
I have a similair case who had non -union after supracondylar nail, which broke at the fracture site. I had to take the nail out and then fixed it with LISS_DF (locking plate) I did use the bone graft. fracture healed with 3 months.
If fixation is solid fracture unite very well provided the environment of the fracture is suitable.
anothe non-union was fixed with Fixed angled monoblock plate. (not DCS) and fracture healed, when augmented with bone graft.
My experience is very pleasantuptill now.
thank you all for keeping us updated
MR Mohammad Maqsood
consultant orthopaedic surgeon
Lincoln county Hospital
Lincoln
-----Original Message-----
From: Peter_Trafton@brown.edu
To: ORT-L@www2.aaos.org
Sent: Mon, 7 May 2007 5.29PM
Subject: RE: [ORT-L] [Orthopod] Fwd: [Ortho] The patient with non-union of the distal ...
Meta-diaphyseal atrophic nonunions generally respond better to absolute than relative stability. I presume your “freshening up” would involve taking this nonunion down to obtain an anatomical reduction, after which absolute stability might best be achieved with interfragmentary compression using a blade-plate, or, as others have suggested and I would prefer, if it were available, a locking distal femoral plate. If appropriate bone contact could be achieved, fixation might be enhanced significantly by using the external tension device to compress the fracture. I’d add bone graft.
The following reference, which describes the short “GSH” retrograde femoral nail, seems to offer relevant evidence:
J Orthop Trauma. 1995;9(4):285-91.
Distal femoral nonunion: treatment with a retrograde inserted locked
intramedullary nail. Koval KJ, Seligson D, Rosen H, Fee K.
Between March 1989 and August 1993, 16 distal femoral nonunions (16 patients)
were treated using the supracondylar intramedullary nail. The time between the
initial event and retrograde nailing averaged 33 months. The nonunion level was
infraisthmal in four patients and supracondylar in 12. Operative technique
involved retrograde insertion of a reamed supracondylar intramedullary nail
through the intercondylar notch. Follow-up was available on all patients and
averaged 20 months (range 9-46). Four nonunions (25%) united with a single
surgery at an average of 17 months. A fifth nonunion united at 21 months after
nail dynamization and subsequent nail breakage. The nonunions of two additional
patients united after exchange of a broken retrograde nail. Additional surgical
procedures were performed in six of the remaining nine patients in an attempt to
gain union. At an average follow-up of 16 months (range 9-23), none of the nine
had united. Nine nails fractured at an average of 11 months, all through a screw
hole near the nonunion. Based on these results, we cannot recommend use of the
supracondylar intramedullary nail in its present form for the treatment of
distal femoral nonunions.
Best wishes,
pg trafton
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf Of GPer11@aol.com
Sent: Monday, May 07, 2007 11:19 AM
To: ORT-L@www2.aaos.org
Subject: Re: [ORT-L] [Orthopod] Fwd: [Ortho] The patient with non-union of the distal ...
Would anyone use a retrograde nail in this case? (after freshening up the # site of course)
Gavin Pereira
MBBS, FRCS(Eng), FRCS(Orth)
Consultant Orthopaedic and Trauma Surgeon
University Hospitals Coventry and Warwickshire
Clifford Bridge Road
Coventry CV2 2DX, United Kingdom
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