Publication:

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

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.