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Case Reports
. 2020 May-Jun;10(3):5-9.
doi: 10.13107/jocr.2020.v10.i03.1724.

Exchange K-nailing, Augmented Plating Technique for Atypical Femur Diaphyseal Non-union, and Implant Failure - A Case Report

Vivek M Sodhai  1 , Chetan V Pradhan  1 , Ashok K Shyam  1   2
Affiliations
Case Reports

Exchange K-nailing, Augmented Plating Technique for Atypical Femur Diaphyseal Non-union, and Implant Failure - A Case Report

Vivek M Sodhai et al. J Orthop Case Rep. 2020 May-Jun.

Abstract

Introduction: Atypical femoral fractures (AFFs) have an unpredictable healing process leading to higher complication rates. The literature describes various treatment modalities of non-unions in AFF. We aimed to report a case of non-union with AFF and successful union with exchange K-nailing and augmented plating techniques.

Case report: A 75-year-old lady with 5 years of bisphosphonate intake sustained an AFF at the mid-diaphyseal level after a trivial injury which was fixed with closed intramedullary nailing. Nine months after fixation, she developed refracture at the fracture site with segmental breakage of the nail suggesting non-union. This was managed by the removal of fibrous structures at the fracture site, removal of a broken nail, exchange K-nailing, augmented plating, and iliac crest bone grafting. The fracture healed at 15 months from the injury and achieved good functional outcome at a short-term follow-up of 1 year.

Conclusion: Our case report highlights the challenges of treating diaphyseal AFF and the combined benefit of exchange nailing and augmented plating with bone grafting in treating AFFs with non-union.

Keywords: Atypical femoral fractures; augmented plating; exchange nailing; implant failure; non-union.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Radiographs of the right femur showed a complete fracture of the right femur shaft at the isthmus with the transverse lateral cortex, medial spike, and increased cortical thickening suggestive of atypical nature of this fracture.
Figure 2
Figure 2
Post-operative radiograph showing acceptable reduction and stable fixation with an intramedullary nail.
Figure 3
Figure 3
Radiograph of the right femur showing refracture with segmental breakage of the nail with minimal callus formation.
Figure 4
Figure 4
Radiograph of revision surgery showing fixation with exchange K-nail, augmented plating, osteoperiosteal flaps, and iliac crest bone grafting.
Figure 5
Figure 5
Radiographs at 1-year follow-up showed complete fracture healing with consolidation.
See this image and copyright information in PMC

References

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