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Case Reports
. 2020 Jun 10:11:2151459320931673.
doi: 10.1177/2151459320931673. eCollection 2020.

The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis

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Case Reports

The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis

Nianzong Hou et al. Geriatr Orthop Surg Rehabil. .

Abstract

Background: The supracondylar nonunion of femur in elderly individuals is rare and challenging to manage. Nothing in English literatures or guidelines is available regarding this particular fracture characterized by osteoporosis, soft-tissue contracture, shortening, and joint stiffness. We report a case of an elderly patient with a supracondylar nonunion of the femur, which was successfully treated using staged Ilizarov techniques and dual plating.

Case presentation: An 84-year-old female patient was admitted to our orthopedic department for her pain and soft-tissue swelling around the right knee with claudication and shortening deformity of the affected extremity. She denied any specific history of trauma and had sought traditional Chinese medical attention for 6 months before she presented to our hospital. Diagnosis of the right femoral supracondylar nonunion was made based on the X-ray and computed tomography. Ilizarov external fixator was carried out for successive and slow distraction and gradual correction of the shortening deformity, in consideration of the nonunion was still present. Subsequently, internal fixation with dual plating of the distal femur was performed. Excellent function and patient satisfaction were observed at 6 months of follow-up.

Conclusion: The protocol of Ilizarov technique with subsequent internal fixation of dual plating seems to be an efficient solution to the supracondylar nonunion of femur in elderly patients with osteoporosis. The advantage of the protocol is that it allows knee joint motion, avoids neurovascular complications, and gentle correction of soft-tissue contractures.

Keywords: Ilizarov technique; dual plating; elderly patients; internal fixation; nonunion; old fracture; osteoporosis; supracondylar fracture of femur.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Anteroposterior and lateral radiograph (A and B), CT scan and 3D reconstruction images (C, D, E), and clinical picture (F and G) of the left lower extremity on presentation before operation. And (A) show the shortening is about 5 cm, and (D) and (E) show rotation deformity. CT indicates computed tomography.
Figure 2.
Figure 2.
Clinical picture (A) and anteroposterior and lateral radiograph (B and C) of Ilizarov external fixator during and after the first stage operation.
Figure 3.
Figure 3.
Anteroposterior and lateral radiograph (A and B) of Ilizarov external fixator when the shortening deformity was being corrected 3 days after the first stage and radiograph (C and D) of the shortening deformity had been corrected 3 weeks after the first stage.
Figure 4.
Figure 4.
Clinical pictures (A and B) presenting fibrous nonunion and endosclerosis during the second stage. Anteroposterior and lateral radiograph (C and D) of femoral condyle 1 week after the second stage.
Figure 5.
Figure 5.
Partially callus formation of AP and lateral radiograph (A and B) 1 month after the second stage. Basically bony union of AP and lateral radiograph (C and D) 3 months after the second stage. AP indicates anteroposterior.
Figure 6.
Figure 6.
Clinical pictures (A and B) of 2 months after the second stage presenting partial weight bearing and an excellent motion of knee. Clinical pictures (C and D) of 6 months after the second stage presenting full weight bearing and returned to her routine life.

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