Abstract
Complications after fractures around the knee are becoming less frequent due to better osteosynthesis techniques, greater care of the soft tissues, and strict action protocols. The main complications are malunion and nonunion, and their treatment is difficult and highly demanding. Nonsurgical management is reserved for non-walking patients with no pain and high surgical risk. In most cases, surgical treatment is indicated. Modern osteosynthesis plates with angular stability head screws are an excellent tool which provides good stability and allows early mobilization. Intramedullary nailing is indicated in supracondylar nonunions with good results, but its use is not recommended when the epiphyseal fragment is less than 4 cm. In cases of severe infection, great deformities or great bone defects, external fixation is the main indication. Devices such as Ilizarov or Taylor frame, using small wires and rings, are commonly used. Allografts have a half-life of no more than 15–20 years. Hence their main indication is a young active patient with great articular destruction. The goal is to provide him/her a good quality of life and delay a total knee arthroplasty. The arthroplasty aims to relieve pain and provide good function. It is indicated in patients over 60 years and constrained or revision devices are recommended in all cases. In cases with severe bone loss, tumoral megaprostheses are indicated. Joint fusion (arthrodesis) is the salvage method in cases of arthroplasty failure or non-controlled severe infection. It is not indicated when ipsilateral hip or contralateral knee is fused.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kregor PJ, Stannard JA, Zlowodzki M, Cole PA (2004) Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma 18:509–520
Ricci AR, Yue JJ, Taffet R, Catalano JB, DeFalco RA, Wilkens KJ (2004) Less invasive stabilization system for treatment of distal femur fractures. Am J Orthop 33:250–255
Weight M, Collinge C (2004) Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur. J Orthop Trauma 18:503–508
Graves ML, Ryan JE, Mast JW (2005) Supracondylar femur non-union associated with previous vascular repair: importance of vascular exam in preoperative planning of non-union repair. J Orthop Trauma 19:574–577
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN (2006) Complications after tibia plateau fracture surgery. Injury. 37:475–484
King GJ, Schatzker J (1991) Non-union of a complex tibial plateau fracture. J Orthop Trauma 5:209–212
Davison BL (2003) Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop 32:27–30
Rosen AL, Strauss E (2004) Primary total knee arthroplasty for complex distal femur fractures in elderly patients. Clin Orthop Relat Res 425:101–105
Haidukewych GJ, Berry DJ, Jacofsky DJ, Torchia ME (2003) Treatment of supracondylar femur non-unions with open reduction and internal fixation. Am J Orthop 32:564–567
Hailer YD, Hoffman R (2006) Management of non-union of the distal femur in osteoporotic bone with the internal fixation system LISS. Arch Orthop Trauma Surg 126:350–353
Wu CC, Shih CH (1991) Distal femoral non-union treated with interlocking nailing. J Trauma 31:1659–1662
Butcher A, Milner R, Keith E et al (2009) Interaction of platelet-rich concentrate with bone graft materials: an in vitro study. J Orthop Trauma 23:195–202
Parsons P, Butcher A, Hesselden K et al (2008) Platelet-rich concentrate supports human mesenchymal stem cell proliferation, bone morphogenetic protein-2 messenger RNA expression, alkaline phosphatase activity, and bone formation in vitro: A mode of action to enhance bone repair. J Orthop Trauma 22:595–604
Thomas SO, David Y, Kristen L et al (2012) Mesenchymal stem cells facilitate fracture repair in an alcohol-induced impaired healing model. J Orthop Trauma 26:712–718
Lonner JH, Siliski JM, Jupiter JB, Lhowe DW (1999) Posttraumatic non-union of the proximal tibial metaphysis. Am J Orthop 28:523–528
Feldman DS, Shin SS, Madan S, Koval K (2003) Correction of tibial malunion and non-union with six-axis analysis deformity correction using the Taylor Spatial Frame. J Orthop Trauma 17:549–554
Saridis A, Panagiotopoulos E, Tyllianakis M, Matzaroglou C, Vandoros N, Lambiris E (2006) The use of the Ilizarov method as a salvage procedure in infected non-union of the distal femur with bone loss. J Bone Joint Surg Br 88:232–237
Bellabarba C, Ricci WM, Bolhofner BR (2002) Indirect reduction and plating of distal femoral non-unions. J Orthop Trauma 16:287–296
Gross AE, Shasha N, Aubin P (2005) Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 435:79–87
Muramatsu K, Ihara K, Shigetomi M, Kawai S (2004) Femoral reconstruction by single, folded or double free vascularised fibular grafts. Br J Plast Surg 57:550–555
Haidukewych GJ, Springer BD, Jacofsky DJ, Berry DJ (2005) Total knee arthroplasty for salvage of failed internal fixation of non-union of the distal femur. J Arthroplasty 20:344–349
Wu L, Xiong Y, Yan S, Yang OS (2005) Total knee replacement for posttraumatic degenerative arthritis of the knee. Chinese J Traumatol. 8:195–199
Figgie HE III, Brody GA, Inglis AE, Sculco TP, Goldberg VM, Figgie MP (1987) Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. Clin Orthop Relat Res 224:237–243
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Italia
About this chapter
Cite this chapter
Rubio-Suárez, J.C. (2013). Nonunion and Malunion Around the Knee. In: Rodrìguez-Merchán, E. (eds) Traumatic Injuries of the Knee. Springer, Milano. https://doi.org/10.1007/978-88-470-5298-7_7
Download citation
DOI: https://doi.org/10.1007/978-88-470-5298-7_7
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5297-0
Online ISBN: 978-88-470-5298-7
eBook Packages: MedicineMedicine (R0)