[Ortho] Distal femur non union

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Dear Carel
This is a tough case .The poor kid have experienced many surgery and the 
site of femoral fracture must have bad blood supply. A s a orthopedist , 
how to fix the fracture is a problem that faced with us . The purpose of 
re-operation is realization of rigid internal fixation and less 
aggressive to blood supply.
I prefer the larger intermedullary locking nail with bone graft as my 
first choice, my reason is as followed. IM can place in closed condition 
and consider the centered fixation is more rigider than eccentric 
fixation of plate in the biological mechanism. Whatever to pick out the 
kind of fixation, bone graft is necessary to this patient.
  The wire track infection of external fixation is common and 
don’t realize the rigid fixation, so I gave up it. LC-DCP is 
capable of compressing the fracture, but it need the wilder strip of 
soft tissue.Maybe LISS is the another choice, but it also don’t 
compress the facture effectively.
Best regards,
   Li Ning
The third hospital of Shijiazhuang, Hebei province, China