Surgical Treatment of an Infected Nonunion of the Middle Third of the Femur Associated with Femoral Shortening in a Hemophilia Patient

Abstract

The management of nonunion and limb length discrepancy has remained a constant challenge in hemophilic patients. In this study, we aimed to present the treatment of femur infected nonunion and limb length discrepancy in a twenty-seven-year-old patient with hemophilia type A. A 27-year-old male patient with hemophilia type A referred to our institution for the treatment of right femur infected nonunion and 10 cm shortness of the femur. Resection of the nonunion site and bone-to-bone fixation with autologous bone grafting were performed. Compression to the pseudoarthrosis site and distraction from new osteotomy site were applied with the unilateral external fixator. Union was achieved, and 6 cm lengthening was obtained according to the initial length. Patient was followed up for 7 years. After this treatment, the patient is able to walk with full weight bearing on the affected extremity with 4 cm shortening which is compensated by the heel lift. The results of this case indicate that limb lengthening and treatment of nonunion with the external fixation could be reliable and effective method for hemophilic patients.

Three-stage total knee arthroplasty combined with deformity correction and leg lengthening using Taylor spatial frames and conversion to internal fixation for severe intra- and extra-articular deformities and hypoplasia in a patient with hemophilic knee arthropathy: A case report

“…Appropriate monitoring of bleeding and coagulant activity, as well as intensive support by a hematologist, are necessary for performing surgery in patients with hemophilia [19,20]. Nevertheless, the present case demonstrated that leg lengthening is a possible treatment option for the treatment of leg length discrepancies in patients with hemophilia.…”

Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

“…However, many studies have shown that time of bone healing after fracture does not differ between patients with and without haemophilia . Even, Salduz et al reported a case of successful distraction osteogenesis using an external fixator in a haemophilic patient. In our study, there were no complications associated with bone union.…”

“…,39 Even, Salduz et al40 reported a case of successful distraction osteogenesis using an external fixator in a haemophilic patient. In our study, there were no complications associated with bone union.…”

Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options

“…The most feared complication in fracture surgery is nonunion which is associated not only with bone loss and deformity but also frequently with infection [ 5 ]. Risk factors for nonunion are not only patient dependent such as gender, age, and comorbidities but also features of the fractures itself: open fractures, intraarticular, or comminuted fractures [ 3 ].…”