Presentation on theme: "Mal-union in Femoral Fracture Treated by Titanium Elastic nailing Department of Orthopaedics, College of Medicine, Chung-Ang University, Seoul, Korea Ho-Joong."— Presentation transcript:
Mal-union in Femoral Fracture Treated by Titanium Elastic nailing Department of Orthopaedics, College of Medicine, Chung-Ang University, Seoul, Korea Ho-Joong Jung
Fall from height (4m) Fx femur shaft Rt (distal 1/3) 8yr/Male
Immediate post OP CR/IF with flexible IM nail (TEN nail, AO)
Post OP 1 Month Callus formation (+), but no bridge
Post OP 2 Month Callus formation (+), but no bridge
Post OP 4 Month Extension deformity aggravation
Post OP 6 Month Extension and external rotation deformity
Post OP 6 Month Out toeing gait, T-gait, short limb gait
Post OP 6 Month Hyperlordosis due to extension deformity
Flexion, internal rotation osteotomy 4.5 LC-DCP fixation with bone graft Corrective surgery
Discussion What’s wrong in treatment? This patient was just 8 years old and simple transverse fracture. Nail entry point Postoperative rehabilitation or protection Fracture nature (Fracture location or injury force)
Discussion Relatively short distance (distal shaft fracture) Medial entry point results in Valgus deformity in prox. Tibia Fx. Wrong entry point problem !
Discussion Imm POPPOP 6M
Discussion Lateral nail inserted from too posterior side ! Imm POPPOP 6M
Discussion Imm POPPOP 6M Lateral nail inserted from too posterior side !
Discussion Lateral nail act as a deforming force !
Discussion Postoperative management ROM exercise was allowed without protection at imm-POP. Crutch walking is allowed if the patient is tolerable. This is the first case which showed so terrible result. I have to think it over about post operative rehab.
Discussion Fracture nature Relatively high injury force seemed to be related with delayed union. Distal third fracture tend to have more complication. - related with fixation stability ? - more wide canal, - close to entry point I’ll pay more attention if I meet high injury, distal third femoral fracture, next time ! Flynn et al. J Bone Joint Surg Br, 2006 Cx in TEN of femur Fx in children