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Medical Science Monitor Basic Research


Use of a Titanium Cage and Intramedullary Nails to Treat Distal Femoral Fracture Nonunion in a Patient with Renal Osteopathy: A Case Report

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents

Hongyu Jin, Maoqi Xiong, Hui Zhou, Man Zhang, Xiao He, Dan Pu

China (mainland) Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)

Am J Case Rep 2020; 21:e924565

DOI: 10.12659/AJCR.924565

Available online: 2020-06-08

Published: 2020-07-29


BACKGROUND: Nonunion occurs to approximately 10% of people who suffer from distal femoral fracture, which can be induced by other diseases and medical interventions. CKD and subsequent renal osteopathy are regarded as risk factors for nonunion. Internal fixation is the most widely applied medical procedure to treat distal femoral fracture, the efficiency and stability of which are improved by emerging biological materials. Besides traditional screws and plate, titanium cages and intramedullary nails have been introduced lately to repair nonunion and large bone defects resulting from it, which is a huge challenge for orthopedic surgeons. To the best of our knowledge, this is the first report on a distal femoral fracture patient with renal osteopathy treated by internal fixation enhancement using a titanium cage and intramedullary nails.
CASE REPORT: We report the case of an 84-year-old Chinese woman with renal osteopathy who underwent 4 internal fixation operations to treat a distal femoral fracture. The first 3 surgeries used screws and a plate as internal fixation materials to treat the fracture and nonunion, but did not achieve satisfactory outcomes. In the final surgery, a titanium cage and intramedullary nail were used and the patient recovered soon.
CONCLUSIONS: Doctors should pay attention to patient’s primary health conditions, especially renal disorders, before performing surgeries for distal femoral fracture. It is important to select the most appropriate materials and choose the most suitable surgical method in patients with poor health conditions.

Keywords: Ambulatory Surgical Procedures, Fractures, Bone, Renal Insufficiency, Chronic