Volume 27, Issue 133, March 2023

Role of dual plate fixation for the distal femur fracture to avoid varus collapse in a patient having multiple ipsilateral compound long bone fractures: A case report

Vivek Jadawala^1♦, Aditya Kekatpure², Sanjay Deshpande³, Shivshankar Jadhav⁴, Parth Shah¹, Abhiram Awasthi⁴

¹Post Graduate Resident, Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Maharashtra, India
²Associate Professor, Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Maharashtra, India
³Professor, Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Maharashtra, India
⁴Senior Resident, Department of Orthopaedics, Jawaharlal Nehru College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Maharashtra, India

^♦Corresponding author
Post Graduate Resident, Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Maharashtra, India
ORCID: 0000-0003-0163-9132

ABSTRACT

Open high velocity long bone fractures with bone loss and extensive soft tissue damage in poly-trauma patient presents unique challenges when the course of limb salvage procedure is recommended. The complexity of managing multiple fractures of ipsilateral long bones arises from the need to consider various management factors, such as the open fracture care, method of stabilization, soft tissue covers and bone-grafting technique, while also taking into account the possibility that the implant chosen for one fracture may not be optimal solution for another. In reality, unilateral fracture of the femur neck, femur shaft and floating knee injuries present numerous challenges and dilemma during fixation that surgeons need to take into consideration; yet, reports of patients presenting with such injuries are extremely rare. We present a case of 41-year-old male who sustained ipsilateral fracture of the femoral neck and shaft femur along with fractures of tibia and fibula (floating knee) following a high-velocity two-wheeler collision. He was managed with operative fixation but 3 months post-operatively, the patient developed varus collapse at distal femur fracture site. Patient was then operated again with medial buttressing along with bone-grafting for distal femur fracture. At his most recent 6 weeks follow-up, patient was walking without assistive devices in October 2022. The decision regarding the sequence in which to fix fractures should be based on judgement of the operating team and circumstances at hand. Although these cases are infrequent and challenging to manage, each case requires individualized, tailored approach since no standard protocol exists.

Keywords: Distal femur fracture, floating knee, neck femur fracture, open reduction and internal fixation, plate osteosynthesis, varus collapse, dual plate fixation

Medical Science, 2023, 27, e152ms2804

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DOI: https://doi.org/10.54905/disssi/v27i133/e152ms2804

Published: 20 March 2023