PMC3348692_01
Anteroposterior (A) and lateral (B) radiographs of the left femur 4 months after initial surgery (2 hip-screws) show an impaction of the femoral head into the femoral neck.
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F1
At presentation in our practice after 4 months, the patient was limping in pain and had leg shortening following incomplete fracture healing (Figure 1).
Anteroposterior (A) and lateral (B) radiographs of the left femur 2.5 months after derotational open-wedge osteotomy and before extracorporeal shock-wave therapy show no sign of ossification or calcification in the osteotomy-gap.
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F2
Surgery reduced the length difference to 2.5 cm and improved limping; 2.5-month-postoperative radiographs, however, revealed no sign of ossification or calcification in the 1x4x6 cm osteotomy-gap (Figure 2).
Computed tomography image of the left femur 4 months after osteotomy and 2 weeks after the last extracorporeal shock-wave therapy-session shows an unchanged delayed union in the open-wedge osteotomy-gap.
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F3
Four months after osteotomy, the open-wedge gap still showed no sign of ossification (Figure 3).
Computed tomography image 6 weeks after the last recombinant human bone morphogenetic protein-2 injection shows an approximately 55-60% union of the bone defect.
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F4
On follow-up, 6-week-post-treatment CT images showed an approximately 55-60% union (Figure 4), while later radiographs documented a complete union of the osteotomy-gap (Figure 5).
Nine-month-follow-up anteroposterior (A) and lateral (B) radiographs of the left femur show a complete union of the bone defect.
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F5
On follow-up, 6-week-post-treatment CT images showed an approximately 55-60% union (Figure 4), while later radiographs documented a complete union of the osteotomy-gap (Figure 5).