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Published byDortha Williamson Modified over 9 years ago
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Mal-union in Femoral Fracture Treated by Titanium Elastic nailing Department of Orthopaedics, College of Medicine, Chung-Ang University, Seoul, Korea Ho-Joong Jung
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Fall from height (4m) Fx femur shaft Rt (distal 1/3) 8yr/Male
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Immediate post OP CR/IF with flexible IM nail (TEN nail, AO)
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Post OP 1 Month Callus formation (+), but no bridge
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Post OP 2 Month Callus formation (+), but no bridge
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Post OP 4 Month Extension deformity aggravation
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Post OP 6 Month Extension and external rotation deformity
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Post OP 6 Month Out toeing gait, T-gait, short limb gait
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Post OP 6 Month Hyperlordosis due to extension deformity
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Flexion, internal rotation osteotomy 4.5 LC-DCP fixation with bone graft Corrective surgery
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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)
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Discussion Relatively short distance (distal shaft fracture) Medial entry point results in Valgus deformity in prox. Tibia Fx. Wrong entry point problem !
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Discussion Imm POPPOP 6M
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Discussion Lateral nail inserted from too posterior side ! Imm POPPOP 6M
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Discussion Imm POPPOP 6M Lateral nail inserted from too posterior side !
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Discussion Lateral nail act as a deforming force !
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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.
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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
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Thank you for your kind attention
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