[Ortho] Distal femur non union

[Alexander Chelnokov]

Dear Carel,


[...]

> All with gradual/partial weightbearing etc. Currently 50-100% weight bearing, no pain.
> Soft tissues are intact. No smoking or diabetes.
> CRP <2
>  
> What would you do?


Tough case. Severe injury, many surgeries...
I'd prefer to be less agressive to periosteal blood supply slowly 
reviving after all those plates.
Looks like shortening is not significant yet. So my choice would be 
closed re-nailing with a larger nail. Some time ago an option of dynamic 
locking in comression by special end cap was discussed in the list - 
IMHO it is suitable for this case. The nail will play role of shaft 
endoprosthesis for some years that must be enough for restoration of 
cortical blood supply. Good luck!

___
Best regards,
  Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia