Abstract text (incl. references and figure legends)
Introduction
A presentation of complications after femoral fracture cases aims to give insight into the retrograde analysis of fixation failure. Each case emphasises a parameter important not only in this process, but also in preparation for upcoming surgery.
Material
Case 1 - Implant failure is imminent when not applying principles of stability. Only by guiding biology can one obtain bone healing. This gradually relieves the implant and prevents failure by cyclic loading.
Case 2 - Due to the difference in the anatomical and mechanical axis of the femur, biomechanics plays an important role in fixation constructs. These should be load sharing if possible, especially in the subtrochanteric region, where forces are highest.
Case 3 - Recognising biological problems creates demand for biological solutions. Checking primary x-rays and patient history is a must. In this case, an underlying unrecognised atypical bisphosphonate fracture was obscured by an hypertrophic non union.
Case 4 - Assess the probability of infection and explant all potential foci. All operated metaphysiary femoral non unions should be treated as infected until proven otherwise. In high suspicion cases plan for staged treatment.
Case 5 - Divide the femur into different segments. Remaining healthy bone stock is best used for new fixation points, fractured segments need stabilisation during healing, and bone defects need to be resolved.
Case 6 - In cases with multiple implants stress distribution is crucial. Excluding stress risers from constructs and optimising screw distribution/fixation points increases success rates.
Results
Follow up x-rays from all of the cases will be shown and commented on.
Conclusion
Revision after femoral fracture surgery requires an individualised approach. The host is reviewed and optimised. Mechanical, biological and infectious causes of failure are assessed. Planned surgery should follow healing principles, aim towards load sharing and even stress distribution.
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