title: Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis.
abstract: OBJECTIVE
  Resistant nonunion of distal femoral fractures in the elderly is a great challenge to treat because it is often associated with multiple problems like poor bone quality, arthritis, disuse osteopenia, joint contractures, and implant failure. We treated ten patients with megaprosthesis and report the outcome.
  
  
  METHODS
  Ten elderly patients of resistant nonunion of distal femoral fractures with arthritis knee were treated with megaprosthesis. The median patient age was 74 years (68-85 years). All these patients had undergone at least two prior operative procedures and were operated by us, 24-33 months following the first index surgery. Modular Resection System was used in all the patients.
  
  
  RESULTS
  Eight patients were available for follow-up. Median follow-up period was 4 years. Two patients required extended local wound care for wound skin necrosis. One patient sustained traumatic periprosthetic subtrochanteric fracture following a subsequent trauma. No thromboembolic complications were seen. All knees showed satisfactory alignment and range of motion. Postoperative, median knee society pain score, and knee society function score were 84 (80-88) and 88 (84-92) at last follow-up.
  
  
  CONCLUSIONS
  Megaprosthesis can be offered as a one-stage salvage procedure for difficult nonunion in distal femoral fractures associated with bone loss, osteoporosis, and secondary knee arthritis.
authors.affiliation: Department of Orthopaedics, Indraprastha Apollo Hospitals, Delhi, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Vaishya
authors.forename: Ajay Pal
authors.initials: AP
authors.lastname: Singh
authors.forename: Rohit
authors.initials: R
authors.lastname: Hasija
authors.forename: Arun Pal
authors.initials: AP
authors.lastname: Singh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005264:Femoral Fractures / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D019736:Prostheses and Implants; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016879:Salvage Therapy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome