The patient was a 34-year-old male who had suffered a fracture of the femoral shaft due to a severe accident. The fracture was initially controlled with a plate, but due to nonunion of the bones during subsequent surgery, the nonunion site was controlled with antibiotic cement, lateral plate, and femoral nail. Three months after the cement was placed, the cement was surgically removed and a personalized prosthesis was used for the patient.
Physician profile
Dr. Seyyed Hadi Kalantar
- Orthopedic Trauma Surgeon
- Assistant Professor of Orthopedic and Trauma Surgery
- Tehran University of Medical Sciences (TUMS)
Pre-operative Planning
First, a 3D model of the bones, intramedullary nail, screw, plate, and cement was obtained using CT scan images, and then the height of the prosthesis was obtained by analyzing the defect. Since the doctor did not intend to remove the IM nail, the prosthesis was designed as an anterior-posterior modular design and was also considered for filling the prosthesis with bone graft. To connect the two prosthesis pieces to each other, four screws and two male and female pegs were considered in the design.
The prostheses were made using a 3D printer and, after post-processing, washing, and sterilization with gamma rays, were provided to the physician.
Surgical Treatment
The patient was placed under general anesthesia. First, the screws, lateral plate, and cement were removed. Then, bone resection was performed to reach the living, blood-rich bone. After reaching the height appropriate for the prosthesis, both prosthesis pieces were placed in the correct location and all four screws were closed. Then, the prostheses were filled with prepared allografts and autografts. Finally, the plate and screws were placed.
Post-operative Follow-up
The patient started walking with crutches the day after surgery, and during the three-month follow-up, the patient started walking without crutches and with a slight limp. At the six-month follow-up, signs of bone Osseointegration were observed in the proximal and distal of the prostheses on the radiograph, and the patient had no pain when walking.
Physician’s Conclusion
These prostheses will be very helpful for patients who suffer from nonunion after an accident or complex fractures in the femoral or tibial shaft, and can also compensate for limb shortening in certain cases.
One of the good results of this type of procedure is the shortening of the surgical time and, consequently, the reduction in the patient’s risk of infection.
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Femoral Nonunion in a 34-Year-Old Patient | Dr. Seyyed Hadi Kalantar