Oblique Osteotomy as an Alternative for the Management of Femoral Shaft Non-union

TL;DR

This paper presents a successful treatment of a complex femoral non-union using oblique osteotomy and retrograde nailing after multiple previous failures.

Contribution

The novel use of oblique osteotomy and biplanar poller screws in managing a challenging infected femoral non-union is described.

Findings

Oblique osteotomy and retrograde nailing achieved union in a non-union case after multiple surgical failures.

The patient was able to bear weight within three days post-surgery and showed radiographic union within seven to 11 months.

Modified irrigation and negative pressure wound therapy, along with 12 weeks of antibiotics, successfully managed the acute infection.

Abstract

Femoral non-unions, especially those with transverse non-union lines, pose considerable challenges in orthopaedic practice and often require multiple revision surgeries to achieve union. We describe the management of an infected non-union of the proximal femoral shaft in a patient who initially underwent fixation with an antegrade nail. The removal of the nail led to an additional iatrogenic fracture. The non-union and the fracture were stabilised with a plate and cerclage wires. The plate fixation failed seven weeks later. The patient, a 50-year-old female, had multiple comorbidities and was undergoing immunosuppressive treatment. To facilitate interfragmentary compression, the non-union was resected by creating oblique osteotomy lines, and biplanar poller screws were applied in both fragments around a retrograde femoral nail. The revision fixation was complicated by an acute infection, which required modified irrigation negative pressure wound therapy and an appropriate course of antibiotics for 12 weeks. The patient commenced weight bearing as tolerated three days post-surgery, and the non-union has united in the X-rays in the follow-up appointments between seven to 11 months after the revision fixation.

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