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

Abstract

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. Nagesh C et al. Int J Res Orthop. 2018 Jan;4(1):107-113 International Journal of Research in Orthopaedics | January-February 2018 | Vol 4 | Issue 1 Page 108 indication of knee arthrodesis today remains the infected non-salvageable prosthetic knee joint, which is not amenable to further reconstructive measures.2,3 The advantage of knee fusion in such post traumatic post infected non-unions enables the patient to ambulate quickly, gives painless stable knee with proprioceptive features.In cases of infected supracondylar femoral nonunions with bone loss, the main goal is to alleviate pain, eradicate the infection, achieve stability, and lead them for bony continuity. As the knee joint is the largest joint in the body, with lot of mobility, so, for fusion to occur it needs stability, vascularity and osteoinductive material. The issues here are infection, bone loss, instability and poor soft tissue envelope, unless these issues are identified and taken care the knee fusion will not occur. To address all these issues, Ilizarov frame appears to be savior. The greatest advantage of Ilizarov frame is it gives rotational stability, axial loading, and static and dynamic compression across the knee which is most essential for the fusion of the knee. The same may n...