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Recalcitrant Femoral Nonunion: A Case for Integrated Fixation

This case appears in the HSS publication Grand Rounds from HSS - Management of Complex Cases, Summer 2013 - Volume 4, Issue 2, Case 1

Case 1, presented by Austin T. Fragomen, MD describes a 30-year-male who had sustained open fractures of the left tibia and left femur following a high speed auto accident. He presented to Hospital for Special Surgery 18 months after the injury following IM nailing of the femur and tibia with the development of a septic nonunion of the femur with persistent wound drainage. He presented with poor knee motion and contemplating above knee amputation (Figure 1). Limb salvage was pursued using a staged technique called bone transport-over-nail. Following successful integrated internal and external fixation, the patient maintained protective weight bearing for 6 weeks and began physical therapy concentrating on knee range of motion. The femur healed without any further signs of infection (Figure 4). One year after removal of the external fixator the patient is back at college and walking without an assisted device.

Read full case details in Volume 4, Issue 2 of Grand Rounds - Complex Cases.

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