Quadriceps-splitting midline approach in the treatment of distal femur infected nonunion with stiff knee and severely scarred soft tissues

Background: Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.Methods: We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.Results: 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant in situ. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.Conclusions: In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover

Primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau

Background: Reconstructive operative procedures for post-traumatic deformities of the tibial plateau have been described in literature, though rarely. We report short term follow-up of eleven such cases of primary intra-articular osteotomy.Methods: From 2005 through 2011, a primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau was performed in eleven consecutive cases. The patients were assessed clinically and radiologically at a minimum of 28 months post-operatively. The functional outcome was assessed using Rasmussen score.  Paired ‘t’ test was used to determine the statistical significance.Results: There were eleven male patients. Average follow up was 59 months (range 28 to 159). Articular congruity was restored to acceptable in all patients and varus malalignment was corrected from a mean of 1.5 degrees varus to 5.7 degrees of valgus (statistically significant, two-tailed P value of 0.0056) to an extent comparable to the normal side (mean 5.8 degrees). There were no infections. All patients had good to excellent functional outcome.Conclusions: A primary intra-articular osteotomy and osteosynthesis for malunited medial condyle fracture of the tibial plateau would help to restore mechanical alignment and improve functional outcome