PMC7289063_01
Anteroposterior and lateral radiograph (A and B), CT scan and 3D
reconstruction images (C, D, E), and clinical picture (F and G) of the left
lower extremity on presentation before operation. And (A) show the
shortening is about 5 cm, and (D) and (E) show rotation deformity. CT
indicates computed tomography.
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Imaging and physical examination revealed the following challenges: osteoporosis, shortening about 5 cm, soft-tissue contracture, muscle atrophy, and joint stiffness (Figure 1).
Clinical picture (A) and anteroposterior and lateral radiograph (B and C) of
Ilizarov external fixator during and after the first stage operation.
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At the same time, adequate space presenting between the frame and the skin all around should be verified (Figure 2).
Anteroposterior and lateral radiograph (A and B) of Ilizarov external fixator
when the shortening deformity was being corrected 3 days after the first
stage and radiograph (C and D) of the shortening deformity had been
corrected 3 weeks after the first stage.
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Gradual distraction at the fracture site started 3 days postoperatively for 3 weeks until the shortening and deformity were corrected (Figure 3).
Clinical pictures (A and B) presenting fibrous nonunion and endosclerosis
during the second stage. Anteroposterior and lateral radiograph (C and D) of
femoral condyle 1 week after the second stage.
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A relatively small reconstructive plate was arranged in the anteromedial area of distal femur for the medial column using the single incision with percutaneous screws (Figure 4). Alignment was checked under X-ray image intensification.
Partially callus formation of AP and lateral radiograph (A and B) 1 month
after the second stage. Basically bony union of AP and lateral radiograph (C
and D) 3 months after the second stage. AP indicates anteroposterior.
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Bony union was documented on a radiograph at 3 months after operation (Figure 5).
Clinical pictures (A and B) of 2 months after the second stage presenting
partial weight bearing and an excellent motion of knee. Clinical pictures (C
and D) of 6 months after the second stage presenting full weight bearing and
returned to her routine life.
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In the follow-up afterward, the patient stubbornly refused X-ray examination but she had returned to her routine life without pain and other symptoms at 6 months after operation (Figure 6).