Femoral Supracondylar Malunions with Varus Medial Condyle and Shortening

Abstract

Femoral supracondylar malunions associated with varus deformity of the medial femoral condyle and shortening are rare, and all techniques for treatment of this complication reported to date have limitations. A one-stage antegrade locked intramedullary nailing technique to concomitantly treat these combined disorders was performed in 19 consecutive patients. The following procedures were performed: removal of previous implants, supracondylar corrective osteotomy, one-stage lengthening on a fracture table, antegrade static locked intramedullary nail stabilization, and corticocancellous bone grafting. Seventeen patients with malunions received regular followup for a median of 2.4 years (range, 1.1-5.2 years). Sixteen malunions healed with a union rate of 94.1% (16 patients) and a median union period of 4.5 months (range, 3-7 months). Only one nonunion associated with nail breakage occurred (5.9%; one patient) and one deep infection recurred (5.9%; one patient). Both patients recovered after appropriate treatment. All patients had improved knee alignment and function. Antegrade locked intramedullary nailing is an effective technique for one-stage treatment of combined disorders in patients with femoral supracondylar malunions. Complications can be avoided if patients and surgeons are careful during the treatment course. Protected weightbearing until fracture healing is crucial to successful treatment.

Locked Nailing for Shortened Subtrochanteric Nonunions: A One-stage Treatment

“…According to some reports, one-stage femoral lengthening should not exceed 4 cm to minimize neurovascular complications [17,18,21]. Therefore, in this study, femoral shortening was limited to 5 cm.…”

“…In patients unable to tolerate lengthening, a shoe lift is suggested after union is achieved [21]. Nerve palsy associated with one-stage femoral lengthening less than 4 cm usually is not problematic [17,18,21]. The nerves in the thigh generally tolerate lengthening up to 4 cm well.…”

Distal femoral osteotomy for multidirectional malunion using 3D printing technology: a case-report

“…Comminution is another critical issue for such fractures, which may lead to malunion and, or leg length discrepancy (LLD). In most cases, malunion is a varus deformity in the coronal plane and a recurvatum in the sagittal plane 11 . Restoring this malalignment, usually by femoral osteotomy, is essential as it is related to patient dysfunction and leads to secondary osteoarthritis 12,13 .…”

Study of Clinical Results and Functional Outcome of Patients With Distal Femur Fracture Treated With Dual Plating

“…In the study by Chi-Chuan et al in 2007, where they assessed femoral supracondylar malunions with varus medial condyle and shortening, it was noted that in these fracture patterns, a retrograde nail usually can not be used, as inserting a retrograde nail from the intercondylar notch cannot correct the malalignment [12]. Single-stage antegrade locking intramedullary nailing was noted to be an effective technique for patients with femoral supracondylar malunions with varus medial condyle and shortening.…”

“…Single-stage antegrade locking intramedullary nailing was noted to be an effective technique for patients with femoral supracondylar malunions with varus medial condyle and shortening. They proposed that medial buttress plating is complicated because it is difficult to contour the medial plate after osteotomy and proximity of the femoral artery [12]. In the study done by Salas et al in 2015, where locking plate and retrograde intramedullary nail fixation were compared biomechanically in osteoporotic bones, it was found that the probability of fracture healing (POF) was higher in locking compression plating as compared to intramedullary nailing, 21.8% vs 0.019%, under applied loading conditions [13].…”