Acta Ortopédica Mexicana

Balcells P, Peñalver-Matamoros JM, Villaba-Modol J, Balaguer-Castro M
Interlocking femoral nail and total knee Arthroplasty in one stage for a patient with a femoral diaphyseal stress fracture
Acta Ortop Mex 2018; 32 (3)

Language: Español
References: 12
Page: 163-166
PDF: 178.59 Kb.

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We present the case of an 81-year-old woman who was followed up by the Rheumatology Service for osteoporosis and treated with bisphosphonates for more than five years. She reported a fracture of the distal third of the contralateral femur by a low energy mechanism, treated with retrograde intramedullary nailing the previous year. She presented a clinic of cruralgia and left gonalgia, without previous trauma. A scintigraphy and radiographs were performed to support the diagnosis of stress fracture of the distal third of the left femur and osteonecrosis of the left internal femoral condyle. Thinking about the possible complications of performing two interventions in an elderly patient, we decided to complete the treatment in a single time and by the same surgical approach, trying to resolve the osteonecrosis and the fracture at the same time, with the objective of an early rehabilitation and lower morbidity. A femoral retrograde prophylactic nailing was performed to stabilize the stress fracture and a retentive primary knee prosthesis was implanted for the posterior cruciate ligament by the same surgical approach. There were no incidents in the immediate postoperative period, with ambulation beginning with help 48 hours after the intervention. The fracture consolidated and the patient presented a good functional result of the knee, both in the immediate postoperative period and at three years of follow-up.

Key words: Femoral nailing, total knee arthroplasty, stress fracture.