Jerry Almeroni think it would be very hard to do interlocking nail,1st the medullary canal of the distal fragment is already obliterated and theres a lot of broken screw,my idea is to do locking plate and a lot of bone graft,of course have to freshen the fracture line thouroghly first
Ayman MansourThere is something weird , i can see that there are two plates over each other . Any way the distal part with the broken screws seems sclerotic with a little potential for healing. And that why both plates failed think about resection of a diseased part of bone and do a vascularized graft
Jerry Almeronthanks dr nabard zangana,ill wait for that case,i would help me a lot on how you do it,recanalization and removing the broken screws because we also see a lot of cases here in the phillipines,thanks
Sandeep Bhagwatwhich plate is this i can see two plates, om changes may be present look at the distal medullary cavity it is showing cavity with sclerosis, as there is abundant callus formation we just need to adequately stabilize it by prox femoral locking plate or dcs, or pfn can be done if implants may be removed.
Hanume Gowda S Nthis is hyper trophic nonunion.. needs stability…failure was due to instability… now remove the implants freshen the fracture site take swabs to rule out infection… plate or nail which ever is feasible..I will prefer nail only if I can clear all the broken svrews. long plate with at least 5screws in each fragment… bone graft will not be required..
Jitender Palin my opinion it became hypertrohic after failure of implant, so many screws close to fracture site should give a stiff construct, which probably it was. anyways it is not avascular nonunion, so a little easier to tackle by addressing biology and mechanics
Abhishek PatilI think the second surgeon simply applied a plate on the previous one without touching the bone at all. Removing the broken screws is one hell of a task and would need special oversize drills. Even if u manage to do it there will be little space left for new ones. Treatment of course is as detailed above.be sure to have your entire trauma set and loads of patience when u operate. Of course rule out infection.
Rooshad AhmadDouble plating adds no benifit to the primary implant.. Sclerotic bone means bad vascularity .. So remove the implant.. Or whats possible to remove and use illizarov ring and use the principles of histeogenesis.. Do 10 days compression + 10 days distraction repeatidely for 2 months then do compression for another 2 months.. U will need no graft.. Hope u luck
Siddarth PigilamRemove both plates. Donot waste time on removing broken screw. Freshen fracture site may need shortening a bit that bone grafting .use left side distal femur LCP in reverse manner. It’s hypertrophy non union it needs good rigid fixation. If intra operative any signs of infection u can do LRS fixation, shortening than distraction from distal metaphyseal site
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