Mal-union in Femoral Fracture Treated by Titanium Elastic nailing

Department of Orthopaedics, College of Medicine, Chung-Ang University,

Seoul, Korea

Ho-Joong Jung

Fall from height (4m)Fx femur shaft Rt (distal 1/3)

8yr/Male

Immediate post OP

CR/IF with flexible IM nail (TEN nail, AO)

Post OP 1 Month

Callus formation (+), but no bridge

Post OP 2 Month

Callus formation (+), but no bridge

Post OP 4 Month

Extension deformity aggravation

Post OP 6 Month

Extension and external rotation deformity

Post OP 6 Month

Out toeing gait, T-gait, short limb gait

Post OP 6 Month

Hyperlordosis due to extension deformity

Flexion, internal rotation osteotomy 4.5 LC-DCP fixation with bone graft

Corrective surgery

Discussion

What’s wrong in treatment? This patient was just 8 years old and simple transverse fracture.

Nail entry pointPostoperative rehabilitation or protectionFracture nature (Fracture location or injury

force)

Discussion

Relatively short distance(distal shaft fracture)

Medial entry point results in Valgus deformity in prox. Tibia Fx.

Wrong entry point problem !

Discussion

Imm POPPOP 6M

Discussion Lateral nail inserted from too posterior side !

Imm POPPOP 6M

Discussion

Imm POPPOP 6M

Lateral nail inserted from too posterior side !

Discussion Lateral nail act as a deforming force !

Discussion Postoperative management

ROM exercise was allowed without protection at imm-POP.Crutch walking is allowed if the patient is tolerable.

This is the first case which showed so terrible result.I have to think it over about post operative rehab.

Discussion Fracture nature

Relatively high injury force seemed to be related with delayed union.

Distal third fracture tend to have more complication.- related with fixation stability ? - more wide canal, - close to entry point

I’ll pay more attention if I meet high injury, distal third femoral fracture, next time !

Flynn et al. J Bone Joint Surg Br, 2006

Cx in TEN of femur Fx in children

Thank you for your kind attention