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3D computed tomography of the right femur after admission to our emergency department. The images show the fractured femur on the second day after an accident. (a) Femur from dorsal view, where the multifragment characteristic of the fracture can already be assumed. (b) Corresponding ventral view of the femur.
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After arrival at our emergency department, we performed 3D computed tomography to better understand the morphology of the fracture (Figure 1).
Clinical picture of the fractured femur in the operating room (a). Intraoperative picture of the situs after repositioning of the fracture (b).
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The alignment of the femur was reconstructed by careful manual extension on the leg (Figure 2).
Intraoperative C-arm images. (a) Three major fragments after reduction temporarily fixated with a sharp reduction clamp. (b) Retrograde implantation of the ESIN.
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Then, the three parts of the fracture were reduced with sharp reduction forceps (Figure 3(a)). When sufficient reduction was achieved, a 3.5 mm elastic stable intramedullary nail (ESIN) was carefully inserted from a retrograde position (Figure 3(b)).
Postoperative radiographs from the second day after surgery. (a) Operated femur in the anteroposterior plane. (b) Corresponding lateral plane. A near-anatomical reduction of the femur has been achieved.
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The radiograph showed sufficient bony healing six weeks after the osteosynthesis (Figure 4).
Peri-implant refracture four months after the initial surgery. (a) Anteroposterior view. The red arrow indicated the fracture. It is only minorly dislocated. (b) The corresponding lateral view shows the fracture and the unchanged position of the ESIN.
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He came to our emergency department with the help of his wife, and a peri-implant fracture was diagnosed without failure of the ESIN (Figure 5).
PMC7374205_02
Bony healing 6 weeks after conservative treatment of the peri-implant fracture. (a) Anteroposterior view. The fracture is almost not visible anymore. (b) Lateral view. Callus tissue indicates the healing process of the bone. A gap can be seen, so we developed a scheme for the gradual increase of weight bearing.
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The patient was treated in our outpatient clinic, and the radiograph showed sufficient bony healing six weeks after the refracture (Figure 6).