Dr.Ehab Farhan; FRCSI MSc(ortho)
 

Dear Dr. : Thank you referring this case.

I would like to do immediate reconstruction from proximal and distal as well with immediate shortening of up to 5 centimeters at the bone loss site to try to achieve earlier coaptation and union with continous lengthening from the proximal half of the femur and the proximal tibia.

It is a technically demand operation. I would prefer to use TSF for accurate bone transport at the end.

Please, let me know if i can be for any further help.

YASSER ELBATRAWY, MD

LECTURER OF ORTHOPEDIC SURGERY, AZHAR UNIVERSITY.
AOAA MEMBER,
ASAMI INTERNATIONAL MEMBER,
ASAMI NORTH AMERICA MEMBER,

SICOT MEMBER,
EOA MEMBER,

WEB SITE: www.elbatrawy.com

Mobile phone: +20101435969

Thanks Mamoun for sending this Case. I think he is fortunate to have his distal femoral condyles. If the wound is clean and no sign of infection the best option, I think, would be a Vascularized fibular graft provided an angiogram shows at least two vessels, and this would be my first choice, I will bridge the fragments with a distal femoral LCP plate. Bone transport would be another option Which has the risk of pin tract infection and ending up with a very stiff knee because of the long period needed for that.

best Regards

Wa'el
 

Dear Dr ,

I would suggest vascularized bone grafting.

It's possible now in our reconstructive microsurgery unit.

Hope you best of luck,

Yours,

Dr. Mohammed M Kotb, MD Ortho
Lecturer Orthopedics, Assiut University Hospital,
Egypt
Currently, director of reconstructive microsurgery
unit, Saudi German Hospital, Jeddah, Saudi Arabia
PO box; 2550, Jeddah 21461
Tel. 00966-2 6829000/6394000
Fax. 00966-2 6835874/6905038
Mob. 00966-558543389

Dear sir

You Sir could try putting vascularized fibular graft (after active signs of inflammation disappear) with Ilizarof External Frame at the docking site to stabilize the defect.

Donot go for primary shortening or lengthening of the femur just obtain union at both sides then adjust.

Thanks a lot for your valuable time in reading and replying my email.

Yours

Mohamed ElSalamouny, AOAA

Trauma Surgeon

Mobile +966 551854858 

Fax     +966 46242065

Email: mohamed.elsalamouny@aoalumni.org

DEAR DR

a really challenging case

just missing the pic of the local soft tissue status

i wound have fixed th tibia at the initial setting , may be unreamed nail (acc to whether open or closed

for the femur i would think of one of two options:

the first: acute shortening (as much as soft tissue allow)+segment tranfere after a subtrochanteric corticotomy with an ilizarov frame or orthofix. i would span the knee with a ring in the tibia and articulationg hinges to allow early ROM of the knee (which would otherwise be hazardous in the expected presence of insufficient fixation in the femoral conyles), however the patient should know that the proceedure will be lenghty and multiple frame adjustements might be neade every now and then and that pin tract infection is the only limiting complication.  a degree of knee stiffness wil be inevitable

the second: harvesting of one or both fibulas( as much as needed to bridge the defect), fixation with aa circular or hybrid frame)

we have a series of succcesfull outcomes usisng non vascularized fibulae to bridge post tumour resection gaps up tp 25 cm long

good luck