Discusión entre pares / Fracture femur crif done two years back….

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
  • Bassem Ezzat Nonunion

  • Jim Bryan Pantas Exchange nail with a bigger one.
    6 horas · Me gusta · 3

  • Ehab Assawy Exclude infection , by inflammatory profile request , then hypertrophic nonunion management .

  • Raj Singh Closed intra medullary nailing bigger size.
    6 horas · Me gusta · 1

  • Gustavo Adolfo Mendoza Orta Interesting, 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.
    6 horas · Me gusta · 3

  • Sanjay Kumar Tiwari nail 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.

  • Sanjay Kumar Tiwari bigger nail or even compressing plating with bone grafts

  • Gustavo Adolfo Mendoza Orta There is much writen about it
    guidelines fr AAOS vit D and non union incidence

  • Drmahesh Dama exchange nailing and start cap cissus quadrangularis

  • Harsh Manoj horsehoop type of vascular nonuniun suggestive of unstable fixation ,(as appriciable nail is of small diameter ) treatment should be closed exchange nailing with thick and short nail

  • Manav Luthra History of smoking

  • Bahaa Mahmoud hyper trophic nonunion ttt by better fixation by bigger nail

  • Ahmad W. Tolba exchange nailing and reaming for bigger diameter nail, hurry before implant failure !!
    4 horas · Me gusta · 1

  • DrRowis Bajnef it seems there is no proximal locking … proximal locking may solve the problem

  • Ram S. Suryawanshi Classical 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.
    3 horas · Me gusta · 1

  • Ram S. Suryawanshi Not serrations but derotation plating.

  • Ram S. Suryawanshi And not illusive but illiac crest.

  • Gustavo Adolfo Mendoza Orta I 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.
    3 horas · Me gusta · 2

  • Seyyed Siamak Rezanezhad Reamming and IM nailing 1-2 size larger.

  • Amit Kumar exchange nailing

  • Hardik Patel even after such aggressive attempts it has nt united .
    Tough case to handle.
    Evaluation for causes of non union required.

  • Hardik Patel Are all surgeries done by you only at 1 place= hosp.?

  • Hardik Patel Or different surgeons at different places?

  • Shalin Maheshwari plate over nail with bone graft.. have seen numerous such long bone fractures with non-union after nailing. They responded beautifully with plate augmentation with nail in situ.

  • Freddy F Galvis Gomez remove distal screwa plus ldcp plating narrow 4,5.plus new graft.
    55 min · Editado · Me gusta · 1

  • Ashwini Sood Some querries ?
    1 Was it a open # to begin with ?
    2 Age of the pt.
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