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Case Reports
. 2020 Jan 7:25:100276.
doi: 10.1016/j.tcr.2019.100276. eCollection 2020 Feb.

Femoral non-union above a fused knee: Successful treatment with exchange nailing and intramedullary delivery of bone morphogenetic protein

Marilena Giannoudi  1 , Michalis Panteli  1 , Emmanuele Santolini  2 , Peter V Giannoudis  1   3
Affiliations
Case Reports

Femoral non-union above a fused knee: Successful treatment with exchange nailing and intramedullary delivery of bone morphogenetic protein

Marilena Giannoudi et al. Trauma Case Rep. .

Erratum in

Abstract

Bone healing is a complex and well-orchestrated physiological process, in which bone repairs and regenerates regaining its original biomechanical and biochemical properties. It is estimated that 5 to 10% of all fractures are complicated by delayed union or non-union. Progression to non-union is thought to be multifactorial, even though the exact biological sequence remains obscure. Treatment should aim to addressing deficiencies in both the mechanical and biological components, along with eliminating co-factors that could negatively affect the locally induced fracture healing response. We report a case of a 78-year-old patient who presented with a distal femoral non-union above a previously fused knee, which was successfully managed with exchange nailing and intramedullary delivery of recombinant human bone morphogenetic protein-7 (rhBMP-7).

Keywords: BMP; Femur; Fused; Nail; Non-union(s).

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Conflict of interest statement

All authors declare no conflict of interest. No funding was received for the completion of this project.

Figures

Fig. 1
Fig. 1
Plain radiographs of the left lower extremity showing a supracondylar distal femoral fracture (AO classification: 33-A2). a) AP b) Lateral.
Fig. 2
Fig. 2
Intra-operative fluoroscopy projections (primary procedure). a) AP view at the fracture site showing distal locking b) AP view at the proximal femoral site (cephalomedullary screw option).
Fig. 3
Fig. 3
Plain radiographs of non-union to left distal femur, ten months post primary procedure. a) AP view at the fracture site b) Lateral view at the fracture site.
Fig. 4
Fig. 4
CT scan of non-union to left distal femur, eleven months post primary procedure. Confirmed the presence of an atrophic non-union with a gap of 6.5 mm at the fracture site. a) Transverse projection b) Sagittal projection.
Fig. 5
Fig. 5
Intra-operative pictures and fluoroscopy views (revision procedure). a) Picture of the plastic tube used to load and to deliver the rhBMP-7 (one vial was used) b) Advancement and delivery of BMP-7 using the guide wiring within the plastic tube c) Fluoroscopy projection for guidance of the rhBMP-7 at the fracture site (red arrow points the marking sign on the plastic tube). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 6
Fig. 6
Plain radiographs of non-union to left distal femur, four months post revision surgery. a) Knee — AP b) Knee — lateral c) Left hip — AP.
See this image and copyright information in PMC

References

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