Fixator-Assisted Femoral Lengthening Following Intramedullary Exchange Nailing for Subtrochanteric Non-union.

Abstract

Non-unions in the femur can be a severely debilitating condition. When a non-union results in significant shortening and leg length discrepancy, simple activities of daily living become extremely difficult and painful tasks. Here, we present a 36 year-old male who presented three years following a motor vehicle accident, complaining of severe left thigh pain and a short left lower extremity. Initially treated in Egypt with an intramedullary nail (IMN) and distal screws, work-up revealed an aseptic subtrochanteric femoral nonunion with a leg length discrepancy of approximately 6.5 cm. The patient subsequently underwent exchange nail with rail fixator placement and was lengthened over the nail. After achieving adequate length, the patient underwent a second exchange nail, which was complicated by IMN instability. Due to the IMN instability, the patient underwent a third exchange nail with blocking screws, and finally healed. On final follow-up, the patient was pain free and no longer felt the leg length discrepancy, with an overall discrepancy of approximately 1.5 cm.