The patient was a 56-year-old man facing nonunion in proximal femur, 8 cm of femoral bone on the anterior side and 6 cm of posterior side of the bone. During the last surgery on the nonunion site cement and nail has been placed.
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 and the cement was generated and the length of prosthesis was determined based on analyzing the defect. the diameter of the nail’s location was designed adequate to the previous placed nail with 4 screw places and pegs. The implant was printed with 3D printers and after processing, washing and sterilization with Gama rays was provided to the doctor.
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 went under spinal anesthesia. At first the cement was removed and after preparing the distal and proximal bones at first the anterior part and then the posterior at of the prosthesis were located firmly around the nail and fixed by closing the screws. Eventually the porosity of the prosthesis was filled with prepared grafts.
Post-operative Follow-up
After 10 months the patient’s pain decreased and started to walk without cane. In 10 months’ follow up the signs of bone union at the distal and proximal parts of the bone were visible in X-ray graph and the patient limps while walking due to abductor muscles weakness.
Physician’s Conclusion
Reconstruction bone shaft’s prosthesis are suitable for patients with crushed and nonunion in bone’s shaft and after control of infection with cement, after 3 month this kind of prosthesis locate in the defect site of the bone during surgery process and the patient would be able to walk and loading the prosthesis one day after surgery.
As the privileges of customized implants sing the CT Scan imaging, design is based on the bone’s geometry and the implanted nail, the length of the defect and the required length in order to reach the proper fixation and stability.
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Femoral Shaft Reconstruction with Custom Implant in a 56-Year-Old Male | Dr. Seyyed Hadi Kalantar