Fracture femur crif done two years back, dynamisation done one and half years back,bone grafting done one year back.Now patient has limping gait and minimal pain at # site on deep palpation.how to proceed
Gustavo Adolfo Mendoza OrtaInteresting, managed according to all principles and yet a non union. Closed reduction, dynamization and grafting. I would go not only for mechanical aspects. Agree with ruling out infection but try a metabolic approach. vit d levels and supplements parathyroid profile , malnutrition.
Sanjay Kumar Tiwarinail was less diameter and there was some distraction at fracture site hence non union ….does low calcium level or low vit d or parathyroid disorder lead to non union?????is osteopathic bone prone to non union ??? i don’t think so.
Ram S. SuryawanshiClassical case of hypertrophic nonunion due to ROTATIONAL INSTABILITY. other causes less likely. U do serrations plating. Just open laterally, put a 5 hole staggered plate with 2 screws above and below. Shingle bone, put illusive crest graft, forget it. It WILL unite.
Gustavo Adolfo Mendoza OrtaI think this is a wonderful example of to approach many issues. If we look it retrospectively, it is very easy to give recommendations and advices all based either by EVM or own experience, both with valid results. However, I would urge all of us to approach it prospectively. This case, in my opinion with the information provided was well approached with a high probability of union from the start. We all have had cases with this configuration that unite, This case evolved to non union. There are many factors, the bone is NOT only a mechanical responsive TISSUE. It involves both mechanical properties with biological proceses and responses. Approach it only mechanically and you will have a porcentages of failures, approach it biological will have the same. Approach it BOTH. There is many evidence about the involvement of subclinical infection even with normal labs. Vitamin D low level even in populations with good exposure to sun.