PMC9852061_01
Preoperative sagittal CT of bilateral knees: the right knee (A), the left knee (B).
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F1
Radiographs revealed a comminuted fracture of both distal femurs, with the fracture line either close to or partially distal to the anterior flange edge of the femoral prosthesis, especially on the left side (Figures 1, 2A, 3A).
Anteroposterior and lateral radiographs of the left knee: preoperative x-ray image (A), postoperative x-ray images (B), radiograph 7 months after surgery (C), radiograph 9 months after surgery (D), radiograph 21 months after surgery (E), radiograph 34 months after surgery (F).
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F2
Radiographs revealed a comminuted fracture of both distal femurs, with the fracture line either close to or partially distal to the anterior flange edge of the femoral prosthesis, especially on the left side (Figures 1, 2A, 3A). The range of motion was 90 -0  intraoperatively, and the fracture alignment was satisfactory postoperatively (Figures 2B, 3B). At 7 months postoperatively (Figures 2C, 3C), shockwave therapy was regularly performed for 16 months due to poor callus growth at the fractured sites of bilateral fractures (more evident on the right side). At 9 months postoperatively, callus formation began on the left side (Figure 2D); however, healing on the right side was not evident (Figure 3D).
Anteroposterior and lateral radiographs of the right knee: preoperative x-ray image (A), postoperative x-ray images (B), radiograph 7 months after surgery (C), radiograph 9 months after surgery (D), radiograph 21 months after surgery (E), radiograph 34 months after surgery (F).
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F3
Radiographs revealed a comminuted fracture of both distal femurs, with the fracture line either close to or partially distal to the anterior flange edge of the femoral prosthesis, especially on the left side (Figures 1, 2A, 3A). The range of motion was 90 -0  intraoperatively, and the fracture alignment was satisfactory postoperatively (Figures 2B, 3B). At 7 months postoperatively (Figures 2C, 3C), shockwave therapy was regularly performed for 16 months due to poor callus growth at the fractured sites of bilateral fractures (more evident on the right side). At 9 months postoperatively, callus formation began on the left side (Figure 2D); however, healing on the right side was not evident (Figure 3D). An x-ray revealed callus formation on the right side 21 months after surgery (Figure 3E), indicating partial weight-bearing. At 34 months postoperatively, films revealed healing (Figure 3F), and the patient could walk normally without the walker.
Coronal CT image of the right femur one year after surgery.
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F4
Although the fracture line had extended the anterior flange edge of the femoral prosthesis, both prostheses were stable (Figures 4).
Fracture end (arrows), intraoperative image of the left knee (A), intraoperative image of the right knee (B).
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F5
Computed tomography revealed no apparent callus formation between the bone fragments one year after surgery (Figure 5).