Non union femur fracture - 4 years on

[Geoff33]

I fractured my femur (comminuted - open fracture) 4 years ago in a car accident.  I have had an intramedullary nail in for the whole time (changed once) and 5 operations in total, including 2 bone grafts onto the fracture site.

The situation now is that I am in a little pain (mainly due to a 1 inch shortening of the leg), but overall not in a bad position (i go cycling and am reasonably active).  However, xrays show that the bone is still not united - see photo.  My surgeon (a non union specialist) wants to operate and fit an ilizarov frame for up to a year with the aim of compressing the fracture site and lengthening the leg further down the femur to correct for the length discrepancy.  

What I would like to know, is if there are any alternatives to this?  My surgeon stated that doing nothing would be risky as the nail could fatigue at any time (I am over 100kg).  Are there any new treatments being tested or any specialists in the US that can offer a less obstructive alternative to the ilizarov.  

Any comments would be appreciated.    

[JainMD]

Hi,
I can understand that you are in discomfort for long time. You being 100kgs are also deterrent for further union of bone. As upon weight bearing you might see persisting non-union.
The process of forming new bone by slow, gentle stretching is called distraction osteo-genesis.
1 method of lengthening was developed in Kurgan, Russia, by G. I. Ilizarov as a means of slowly and completely correcting many congenital and acquired abnormalities.
The Ilizarov method uses a versatile external fixator to produce gradual changes in the length and alignment of an extremity.
The fixator consists of circular rings attached to bone with wires.
These rings are distracted (spread apart) by threaded rods.
Each fixator is custom assembled for the given patient and indication.
Fixators other than the Ilizarov (versatile but tend to be bulky) may be used:
Mono-lateral fixators and spatial frames
If complex rotation and angular correction are not needed, fixators with PINS in a straight line may be used (many different models are available).
Nevertheless, the principles described here are general and apply not to the device but, rather, to the concept and procedure.
The Ilizarov method is applicable to all extremities, but it is used most commonly in the lower extremities where alignment is more critical than in the upper extremities.
For certain indications, this procedure can be performed in younger patients (with severe congenital abnormalities) or in adults (with non-unions and acquired deformities).
In deciding whether this treatment method is appropriate for a given individual, the physician should determine the degree of functional impairment, degree of patient adaptation, and degree of patient understanding and motivation to undergo a treatment that lasts for many months.
The results usually are good, although problems and complications may require additional procedures before completion.
An 80 to 90% success rate may be expected, although the healing time often is prolonged.
Keep me informed if you have any queries.
Bye.

[Geoff33]

What I really need to know is if there are any alternatives to the Ilizarov?  
Anyone heard of anything?

[JainMD]

Hi,
There is Bliskunov's method for limb lengthening.
Please go through the method and let me know if you have any queries.
Bye.

[Chele446]

Hi

I fractured all the bones in my ankle and suffered an open fractuer to my femur two years ago in a road traffic accident.

I had an external fixator put on the lower part of my leg for 11 months and a pin and screws put in my femur, and my leg is now one inch shorter.

I have had ten operations to date and it now turns out that my femur is not uniting.  My consultant thinks that the only option I have is to have an external fixator fitted to my femur.  I have refused because I know what I went through with it on the lower part of my leg and I wont go through that again.  I have told them they have to find an alternative.

I will let you know if they come up with anything.

Good Luck

[gg42]

I am 3 months post-op ORIF for comminuted distal femur fracture.  My question is how do I know that my surgeon is "handling" my case correctly.  I do not have union or alignment.  I will start using a bone stimulator today.  If this does not work, bone graft or knee/femoral replacement.  I know that the info that I have provided is vague, but does this "sound right"?

[Dr Vinod]

The first thing is belief in your treating orthopaedician. You have to select always an experienced one and your doctor should treat you after explaining all pros and cons and as you know every case is different and by this you will know much about your doctor.These surgeries and treatment require long term relationship between the patient and the physician and going step by step and conservatively is always good. If conservative treatment does not work surgery is the option.
So you can follow his advice in your case and you always have an option to take a second opinion. Take care!

[binod6]

  Well my name is Binod Bhattarai.At the age of 22 I got my left femur fractured(subtrochantric close fracture) and was managed IMIL DYNAMISATION done after one month surgery by one of the US product ortho surgen.And  it turned to be  atrophic non union so bone graft  was done after 14 months,and bone marrow syringe was given for two times after three months of BG.So  as still was  non union and it turned  implant failure fracture after 22 months of bone graft and now again ORIF withDCS985mm,10hole+bone Graft,was done before 5 months.Now still I M in Non weight bearing walk so may be it  will healing slowly,god knows.
I think as I was really young and healthy and gave off smoking and ocassional drinking too after  truma but  I became the victim of non union ,although the doctor was the one of the reputed and most expenxive doctor of Nepal.Till I spend 5000$ on treatment only.On the first stage of non union I requested him to refer me any western countries as I am capable to spend 20000$ just to be recovered but he did not insted he surguried again and again........Getting money and being Handicapped through out the life although the treatment is possible in Next part of world i could not do the proper treatment too,It might be because of being a CITIZEN of thirld world.............NEPAL
Its totally unfare that the poor people too of western countries can live healthy but everyone of Thirdworld should remain unhealthy tthroughout their life though the treatment is possible in Next CORNER of the earth.........
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