DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20200572

Quadriceps-splitting midline approach in the treatment of distal femur infected nonunion with stiff knee and severely scarred soft tissues

Jeremy Bliss, Dan Barnabas Inja, Manasseh Nithyananth, Vinoo Mathew Cherian

Abstract


Background: Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.

Methods: We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.

Results: 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant in situ. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.

Conclusions: In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover.


Keywords


Infected non-union, Distal femur, Quadriceps-splitting

Full Text:

PDF

References


Struijs RWPPA. Infected Nonunion of the long bones. J Orthop Trauma. 2007;21(7):507-11.

Whitney TM, Heckler FR, White MJ. Gastrocnemius muscle transposition to the femur: how high can you go? Ann Plast Surg. 1995;34(4):415-9.

Wang YC, Hart DL, Stratford PW, Mioduski JE. Clinical Interpretation of a Lower-Extremity Functional Scale-Derived Computerized Adaptive Test. Phys Ther. 2009;89(9):957-68.

Garvin KL, Scuderi G, Insall JN. Evolution of the Quadriceps Snip. Clin Orthop Relat Res. 1995;321:131-7.

Gwathmey FW, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. J Am Acad Orthop Surg. 2010;18(10):597-607.

Whiteside LA. Exposure in Difficult Total Knee Arthroplasty Using Tibial Tubercle Osteotomy. Clin Orthop Relat Res. 1995;(321):32-5.

Khalil AE-S, Ayoub MA. Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution? J Orthop Traumatol. 2012;13(4):179-88.

Chapman MW, Finkemeier CG. Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft. JBJS. 1999;81(9):1217-8.

Kanakeshwar RB, Jayaramaraju D, Agraharam D, Rajasekaran S. Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients. Injury. 2017;48:14-7.

Vaishya R, Singh AP, Hasija R, Singh AP. Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2011;19(7):1137-40.

Ebraheim NA, Buchanan GS, Liu X, Cooper ME, Peters N, Hessey JA, et al. Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate. Orthop Surg. 2016;8(3):323-30.

Wang J-W, Weng L-H. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Jt Surg Am Vol. 2003;85(3):436-40.