The patient was a 21-year-old man facing nonunion of femur’s bone midshaft after numerous accidents and surgeries. During the surgery the bone necrosis were removed and at the same time femoral nail and cement were placed at the defect site.
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
In order to generate a 3D model of the bone CT Scan imaging was done with 1 mm thickness of slices of both femoral bones. The 3D model of bones, the cement and the nail were generated and the measure of defect calculated which was equal to 115 mm in the anterior section and 68 mm in the posterior section. To prevent the removal of the healthy bone the mesh cage’s defect was designed with 25 mm height at the most distal site. The mesh cage locks into the anterior part using morse taper connection. the anterior and posterior after the design of prosthesis shaft had 4 screw’s sites and two pegs and in order to prevent the rotation of prosthesis, a flange was designed in the proximal section of anterior part of the prosthesis.
Surgical Treatment
The patient went under spinal anesthesia. At first the cement was removed and then the necrosis of bones at the defect site were removed. At first the anterior and the posterior part were connected using the designed pegs around the nail at the defect site and the screws were closed. 4. Mm screws at the designed places at the proximal flange were set. The porous of the prosthesis were filled with graft at the end. Graft was used at the distal site of defect and then the mesh cage was locked in the anterior part in order to hold the grafts.
Post-operative Follow-up
