J Korean Fract Soc.  2012 Apr;25(2):136-141. 10.12671/jkfs.2012.25.2.136.

Repeated Metal Breakage in a Femoral Shaft Fracture with Lateral Bowing: A Case Report

• Kim DS
• Kim YM
• Choi ES
• Shon HC
• Park KJ
• Cho BK
• Park JK
• Lee HC
• Hong KH

• KMID: 2015457
• DOI: http://doi.org/10.12671/jkfs.2012.25.2.136

Abstract

Fractures of the femoral shaft with marked bowing face some obstacles in fixation of the fracture such as difficulty in insertion of the intramedullary nail (IM nail) or exact contouring plate. Locking compression plates (LCP) are an option to manage this problem. However, we experienced consecutive breakage of LCP twice and IM nail once in an 80-year-old female. Finally, union of the fracture was achieved after fixation of the IM nail and additional plate together. Fractures of the femur shaft with marked bowing are thought to have different biomechanical properties; therefore, we present this case with a review of the literature.

Keyword

Femur shaft fracture; Lateral bowing; Metal breakage; Locking compression plate; Intramedullary nail

MeSH Terms

Aged, 80 and over
Female
Femur
Humans
Nails

Figure

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  Fig. 1 (A) Right femur has marked anterior and lateral bowing. (B) Initial radiographs show the distal shaft fracture of the left femur (Winquist-Hansen type III).

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  Fig. 2 (A, B) Postoperative radiographs show diminished lateral bowing and gap of medial cortex. (C, D) X-ray at postoperative 3 months shows breakage of the locking compression plate.

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  Fig. 3 (A, B) A second operation was performed using locking compression plate (LCP). (C, D) But 6 weeks later, the LCP was broken again.

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  Fig. 4 (A, B) Third postoperative radiographs show the fracture treated with an antegrade femur nail that preserved the anterior and lateral bowing of the femur. (C, D) 9 months after the third operation, a fatigue fracture occurred at the most proximal hole among the distal locking holes.

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  Fig. 5 (A, B) A fourth operation was performed with antegrade femur nail and locking compression plate. (C, D) One year after the fourth operation, the radiographs show the bony union of the fracture site.

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  Fig. 6 Bending moment increases proportionally to the distance between the plate and mechanical axis. D: Distance.

Reference

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