Abstract
ObjectiveAtrophic distal femur non-union with bone defect (ADFNBD) has been a worldwide challenge to treat due to the associated biological and mechanical problems. The purpose of this study was to introduce a new solution involving the use of a J-shaped iliac crest bone graft (J-bone) combined with double-plate (DP) in the treatment of femoral non-union.MethodsClinically, 18 patients with ADFNBD were included in this retrospective study and were treated with a combination of J-bone graft and DP. The average follow-up time was 22.1 ± 5.5 months (range, 14 to 34 months). The imaging information and knee joint activity tests and scores were used to evaluate the time to weight-bearing, the time to non-union healing, and the knee joint mobility. A finite element analysis was used to evaluate the differences between the following: (1) the use of a lateral locking plate (LLP) only group (LLP-only), (2) a DP only group (DP-only), (3) a DP with a J-bone group (DP+J-bone), and (4) an LLP with a J-bone group (LLP+J-bone) in the treatment of ADFNBD. A finite element analysis ABAQUS 6.14 (Dassault systems, USA) was used to simulate the von Mises stress distribution and model displacement of the plate during standing and normal walking.ResultAll patients with non-union and bone defect in the distal femur achieved bone healing at an average of 22.1 ± 5.5 months (range, 14 to 34 months) postoperatively. The average healing time was 6.72 ± 2.80 months. The knee Lysholm score was significantly improved compared with that before surgery. Under both 750 N and 1800 N axial stress, the maximum stress with the DP+J-bone structure was less than that of the LLP+J-bone and DP-only structures, and the maximum stress of J-bone in the DP+J-bone was significantly less than that of the LLP+J-bone+on structure. The fracture displacement of the DP+J-bone structure was also smaller than that of the LLP+J-bone and DP-only structures.ConclusionJ-bone combined with DP resulted in less maximum stress and less displacement than did a J-bone combined with an LLP or a DP-only graft for the treatment of ADFNBD. This procedure was associated with less surgical trauma, early rehabilitation exercise after surgery, a high bone healing rate, and a satisfactory rate of functional recovery. Therefore, a combination of J-bone and DP is an effective and important choice for the treatment of ADFNBD.
Highlights
Distal femoral fracture is a rare type of fracture with a reported incidence of 8.7/100,000/year in 2005–2010 [1]
Retrospective studies have reported that the complication rates of malunion, non-union, infection, or death after distal femoral fracture are as high as 15–20% [2,3,4,5]
After adjusting the limb length, rotation, and angulation of the fracture, it was stabilized temporarily using a K-wire, and a long lateral locking plate (LLP) was subsequently placed outside the fractured femur
Summary
Distal femoral fracture is a rare type of fracture with a reported incidence of 8.7/100,000/year in 2005–2010 [1]. These fractures are caused by high-energy damage in young people or low-energy damage in the elderly with concomitant osteoporosis. Due to the anatomical shape of the femur [6] and the mechanical effect of the distal femur, atrophic distal femoral non-union with bone defect (ADFNBD) is one of the most difficult subtypes of distal femoral non-union [7] and varus deformity with medial posterior bone defect [8]. Poor bone mass and bone defects at the distal femur present a huge challenge for orthopedic surgeons around the world. A J-shaped iliac crest is a bicortical structural bone graft [9,10,11] used in the conventional surgical procedure for reconstructing the articular hernia to resolve shoulder instability
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