Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A case report

Abstract

The management of post-traumatic bone defects with non-union remains a surgical challenge. Current techniques are often fraught with complications, posing a functional, economical, and psychological challenge for the patient. A 57 year-old gentlemen suffered an open femoral fracture after a motorcycle accident. Having previously undergone open reduction internal fixation, he presented to us with atrophic non-union and bone defects, which were simultaneously treated with a second-generation PRECICE nail. Our treatment protocol was based on the strain theory, and involved initial distraction by ~5 mm at the non-union site, compression of the non-union site, followed by distraction osteogenesis at the non-union site. The patient achieved union and the initially planned limb lengthening regime was achieved with minimal complications. Self-lengthening, magnetically-driven PRECICE nails can successfully restore union and manage limb length discrepancies with reasonable patient satisfaction and minimal complications.

Keywords: Fracture; Limb lengthening; Osteogenesis; Trauma.

Fig. 1

a: AP X-ray of broken distal locking screws, non-union with limited callus formation. b: Lateral X-ray of broken distal locking screws, non-union with limited callus formation. c: AP X-ray showing the leg length discrepancy before PRECICE nail insertion. d: AP X-ray of distraction osteogenesis but no consolidation yet. e: Lateral X-ray of distraction osteogenesis but no consolidation yet. f: AP X-ray of consolidation and union. g: Lateral X-ray of consolidation and union.

Fig. 2

Timeline of events.