title: Supracondylar distal femoral nonunions treated with a megaprosthesis in elderly patients: a report of two cases.
abstract: The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. Despite multiple procedures during a long period, patients had a persistent nonunion. Both patients underwent total arthroplasty with a cemented kinematic rotating hinge and had significant clinical improvement. The Hospital for Special Surgery (HSS) knee scores increased from fifty-four points to seventy points in one patient and forty-two points to seventy-three points after surgery in the other patient. Both patients had excellent range of motion after surgery. A cemented megaprosthesis appears to be a viable treatment option for persistent nonunions of supracondylar femur fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, ACB 3 Bridge, Louisville, KY 40202, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Davila
authors.forename: A
authors.initials: A
authors.lastname: Malkani
authors.forename: J M
authors.initials: JM
authors.lastname: Paiso
mesh_terms: D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome