Limb reconstructions
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Open comminuted distal femoral fracture in the knee with severe OA

19/8/2015

 
Comminuted distal femoral fractures are not easy fractures to treat and heal. If they are open fractures the problem is even bigger. Those fractures are usually seen in the young, active male population, but can happen in the senior age group as well. 

I am presenting a case of an open comminuted distal femoral fracture with a bone defect in the region between 8-10 cm (it depends on how it is measured and if you accept any leg shortening as a result of it). Injury happened as a result of an RTA.
open fracture, compound fracture, distal femoral fracture
Ap view of an open distal femoral fracture with significant comminution and OA of the knee joint.
open fracture, compound fracture, distal femoral fracture
Lateral view of an open distal femoral fracture with significant comminution and OA of the knee joint.

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Femoral shaft non-union post closed non-comminuted fracture fixed using a locked intra-medullary nail

14/8/2015

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femoral shaft fracture, intra-medullary nailing
AP and lateral view radiographs of a femoral shaft fracture nailed in an excellent position.
Picture
Femoral shaft fractures do not have very high tendency to heal without any further intervention. And if the fracture is open, it is even worse.

Currently accepted treatment for majority of the femoral shaft fractures is  locked intra-medullary nailing, reamed or undreamed. Depends on surgeon preferences but also clinical condition of the patient. 

I am presenting a case where femoral shaft fracture was nailed in excellent position after a closed injury but till ended in non-union.

Sometimes reduction of the fracture and nailing without opening the fracture site is impossible, particularly if patients are muscular. To insert intra-medullary guide wire into the both main fragments can become impossible without opening the fracture site and guide the guide wire under visual control.

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Limb alignment correction using TSF fine wire frame prior to the Total Knee Replacement

12/8/2015

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Prior to the knee replacement procedure lower limb should be in a reasonable alignment. Mechanical axis of femur and tibia should fall inside the joint level. Otherwise joint replacement with soft tissue balancing to accommodate for bone deformity is technically demanding if not impossible. 

I am presenting a patient with previous surgeries to his lower limb due to the trauma and subsequent correction of alignment at the level of the femur.

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    Picture

    Mr Matija Krkovic, MD, PhD

    I am Consultant Orthopaedic Trauma Surgeon with special interest in Limb reconstructions and bone infections.

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  • Home
    • Knee Surgery >
      • Symptomatic Osteoarthritis of the Knee >
        • Primary Care >
          • Initial Management
          • Intermediate Care
          • Referral Treshold
        • Secondary Care >
          • Total Knee Replacement
          • High Tibial Osteotomy
          • Knee Arthroscopy
          • Complex Primary Total Knee Replacement
          • Postoperative Management
        • Procedures recommended by NICE
        • Procedures with limitations by NICE
        • Procedures not recommended by NICE
        • Viscosupplementation
      • Trauma to the Knee >
        • Meniscal Injuries
        • ACL Injury
      • Partial v Total Knee replacement
    • Limb Lengthening >
      • Femoral lengthening over the nail
  • Orthopaedic Trauma
    • Complex Trauma Impact
    • Principles of fine wire frame fixation >
      • Indications for fine wire frame
      • Complications >
        • Predictable complications
        • Unpredictable complications
      • Pin sites management
      • Activities >
        • Videos
        • Photos
    • Poller or Blocking screw >
      • Mechanic of Poller screw
      • Without and With a Poller Screw
      • Third Generation Poller Screws >
        • Epicentric poller screws in osteoporotic bone
        • Epicentric poller screws in comminuted spiral fracture
      • Use of Poller Screw(s) in Complex Cases >
        • Segmental Femoral Fracture
        • Low Supracondylar Femoral Fracture
        • Low Supracondylar Femoral Fracture 2nd case
        • Femoral Non-union - Antegrade Nail
        • Femoral Non-union - Retrograde nail
        • Distal Tibia Spiral Fracture
    • VAC irrigation
    • Complex Cases >
      • Femoral diaphysis defect
      • Capitellum Fractures
      • Distal Femoral Fractures
      • Proximal Humerus Fractures
      • Subtrochanteric Femoral Fractures
  • Osseointegration
    • Osseointegration-Physiotherapy
    • Osseointegration-Surgery
    • Osseointegration-NHS Perspective
  • Medico-legal
    • PI Solicitors
  • Blog
  • Contact
    • About
    • CV
  • Blog
  • New Page