PMC4575704_01
Anteroposterior radiograph of the left knee showing comminuted distal femur fracture with bone loss
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He had sustained a comminuted open distal femoral fracture (Gustilo-Anderson classification 3C, (Figure 1).
Surgical view of the femoral spacer
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Anteroposterior radiograph of the left knee showing femoral spacer with external fixator
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Figure 3). 4 months following the injury, and once infection was controlled, at a single operative stage the external fixator and femoral spacer were removed, and a knee megaprosthesis GMRS cemented (Global Modular Replacement System) was implanted with additional reinforcement of the patella tendon using synthetic ligament. Full ambulation was achieved before the patient was discharged from hospital (Figure 4). 45 days after the implantation of the megaprosthesis, the patient presented with extensive necrosis of the extensor apparatus.
Lateral radiograph of the left knee showing pseudo-synovial membrane ossification around the knee megaprosthesis
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Figure 3). 4 months following the injury, and once infection was controlled, at a single operative stage the external fixator and femoral spacer were removed, and a knee megaprosthesis GMRS cemented (Global Modular Replacement System) was implanted with additional reinforcement of the patella tendon using synthetic ligament. Full ambulation was achieved before the patient was discharged from hospital (Figure 4). 45 days after the implantation of the megaprosthesis, the patient presented with extensive necrosis of the extensor apparatus.
Lateral approach of the left leg exposing the lateral gastrocnemius muscle
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This necessitated debridement and patellectomy. 10 days following the patellectomy, a lateral gastrocnemius flap was used to cover the exposed megaprosthesis and restore the extensor mechanism (Figure 5 and Figure 6).
Lateral gastrocnemius flap was passed to cover the exposed knee
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This necessitated debridement and patellectomy. 10 days following the patellectomy, a lateral gastrocnemius flap was used to cover the exposed megaprosthesis and restore the extensor mechanism (Figure 5 and Figure 6).
Anteroposterior radiograph showing good osseointegration of the megaprosthesis one year after knee replacement
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The anteroposterior and lateral radiographs revealed good osseointegration of the megaprosthesis (Figure 7).