DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20175657

Management of infected supracondylar femoral nonunion with bone loss by primary knee arthrodesis with hybrid Ilizarov frame: a study of 10 cases

Nagesh C., Raju Iyengar, P. Chandrasekhar

Abstract


Background: Most of infected nonunion supracondylar femur with bone loss is a challenge to orthopedicians, where amputation is one of the choice. Opinions are divided on the appropriate management of infected nonunion supracondylar femur with bone loss. Evidence supports for both, osteosynthesis with or without salvaging knee joint and above knee amputation.

Methods: 10 consecutive patients at Nizam’s Institute of Medical Sciences, from Jan 2013 to December 2016, who underwent limb salvage with knee arthrodesis for infected nonunion supracondylar femur with bone loss were evaluated and followed till union. Treatment option in the form of osteosynthesis with knee arthrodesis was achieved with hybrid Ilizarov fine wire fixator. The hybrid Ilizarov frame comprised of conventional two ring tibial frame and one ring and one Italian arch in the femoral segment with half treaded pins, this construct was chosen because of less weight, less cumbersome without compromising the stability and basic features.

Results: All patients went for solid knee arthrodesis in functional position, with a mean fusion time of 22.4 ± 4.97 weeks. The time interval between primary surgery and definitive treatment was 15.6 ± 6.37 weeks. The mean shortening of lower limb was 3.1±1.19 cms. To achieve arthrodesis quickly, it’s necessary to have light weight, compact Ilizarov frame, have good bone to bone contact and allow early full weight bearing.

Conclusions: Osteosynthesis with knee arthrodesis in cases of infected nonunion supracondylar femur with bone loss is a viable option in select cases where the patient is physiologically young, has undergone several procedures around the knee and the knee is stiff. Fusion of the knee enables quick restoration of the patient to his work place.


Keywords


Infected supracondylar femur nonunion, Hybrid Ilizarov frame, Knee arthrodesis, Bone grafting

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References


Gunes T, Sen C, Erdem M. Knee Arthrodesis using Circular External Fixator in the Treatment of Infected Knee Prosthesis: Case Report. Knee Surg Sports Traumatol Arthrosc. 2005;13:329–34.

Ramazzini-Castro R, Pons-Cabrafiga M. Knee Arthrodesis in Rescue Surgery: A Study of 18 Cases. Esp Cir Ortop Traumatol. 2013;57:45-52.

Ulstrup AK, Folkmar K, Broeng L. Knee Arthrodesis with the Sheffield External Ring Fixator: Fusion in 6 of 10 consecutive patients. Acta Orthopaedica. 2007;78(3):371-6.

Saridis A, Panagiotopoulos E, Tyllianakis M, Matzaroglou C, Vandoros N, Lambiris E. The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Jt Surg Br. 2006;88:232–7.

Kuchinad R, Fourman MS, Fragomen AT, Rozbruch SR. Knee Arthrodesis as Limb Salvage for Complex Failures of Total Knee Arthroplasty. The Journal of Arthroplasty. 2014;29:2150–5.

Spina M, Gualdrini G, Fosco M, Giunti A. Knee Arthrodesis with the Ilizarov External Fixator as Treatment for Septic Failure of Knee Arthroplasty. J Orthop Traumatol. 2010;11:81–8.

Matthew J Garberina, Robert D Fitch, Eric D Hoffmann, William T. Hardaker, Thomas P. Vail, Sean P. Scully. Knee Arthrodesis with Circular External Fixation. Clin Orthop Relat Res. 2001;382(1):168-78.

Reddy VG, Kumar RV, Mootha AK, Thayi C, Kantesaria P, Reddy D. Salvage of Infected Total Knee Arthroplasty with Ilizarov External Fixator. Indian J Orthop. 2011;45:541-7.

Rodriguez-Merchan EC. Knee Fusion or Above-The-Knee Amputation after Failed Two-Stage Reimplantation Total Knee Arthroplasty. Arch Bone Jt Surg. 2015;3(4):241-3.

Wood JH, Conway JD. Advanced Concepts in Knee Arthrodesis. World J Orthop. 2015;18: 6(2):202-10.

Alt V, Seligson D. Knee Fusion – A New Technique Using an Old Belgian Surgical Approach and A New Intramedullary Nail. Acta Orthopeadica Belgica. 2001;67(1):49-53.