FRACTURE: Revision trauma
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pre op xray with broken nail
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60 yr old female presented with
history of fracture right femur which had been operated twice earlier.
Initially plating of femur was done. The plate failed with implant breakage.
Revision surgery was done with plate removal, nail insertion and bone grafting.
This patient presented to us 2 yrs after nailing procedure with complaints of
shortening of limb, crepitus while walking and slight pain. X rays were done.
There was fracture distal femur with non-union and implant breakage. The nail
had broken at proximal of distal screw site and also screw breakage at this
site. The fracture had collapsed in valgus and the distal fragment was short.
The broken piece of nail was stuck in distal part of nail. Other problems in
this patient were obesity, short stature, and diabetes. The patient was
counseled and consent was taken for shortening in right femur, non-union, and
need for non-weight bearing till good radiological union on x rays. The patient
was taken to operation theatre and broken nail was removed. The fracture site
was opened, bone ends were cut with oscillating saw till bleeding ends, and
distal part of nail removed with long forceps. The fracture was fixed with
locking distal femur plate and screws. The both parts of bone were prepared for
bone grafting with shingling. Cancellous graft was taken from right iliac crest
and put circumferentially around fracture site. Wound was closed over drains.
The patient was closing followed up with x rays. There was delay in healing
callous formation. However, after 9 months satisfactory bridging callous was
seen and full weight bearing was allowed.