Dr. Sinukumar Bhaskaran

Introduction: Distal femur fractures are one of the most common fractures accounting for 0.5% of all fractures with incidence of about 7/100000/year. Majority of the fractures occur in elderly population (above 60 year) with osteoporosis resulting from a low energy trauma. In the younger age group these fractures are associated with high energy trauma. Case report: A 68-year-old male presented with chief complaints of pain and deformity in right knee since 1 year. The patient had a history of distal femur fracture 2 years back for which he was operated twice with distal femur plating and bone grafting. The patient was a known case of diabetes mellitus on medication since 5 years. Radiographs of the right knee in anteroposterior and lateral views were taken, which showed distal femur fracture non-union with a broken locking compression plate with grade 4 knee arthritis. Due to the failure of osteosynthesis twice, and the patient demanding for early mobilization, a single staged procedure with implant removal followed by an arthroplasty using cemented modular distal femur endoprosthesis was planned for the patient. Conclusion: Hinged knee arthroplasty can be considered as a treatment option for patients with distal femur non-union with pre-existing severe knee arthritis. It helps in early weight bearing and return to activities of daily living.

Introduction: : Post-traumatic knee arthritis is defined as any structural osteochondral damage to the knee after an injury. About 12% cases of symptomatic osteoarthritis of the knee mainly due to post-traumatic arthritis. Primary total knee arthroplasty in a post-traumatic arthritic stiff knee with a malunited distal femur fracture is a technically difficult procedure due to secondary deformity, poor bone quality, bone loss, ligament incompetence, tissue adhesion, and stiffness. Case Report: A 65-year-old male presented with chief complaints of pain and stiffness in the left knee for 15 years. On inspection no scar, sinuses, and dilated veins on palpation, tenderness was present over both the medial and lateral joint lines. Radiographs of the left knee in anteroposterior and lateral views were taken, which showed united distal femur fracture with Grade 4 Kellegren Lawrence knee arthritis. Due to severe knee stiffness and with the patient demanding early mobilization and functional knee ROM, total knee arthroplasty with intra-articular and extra-articular adhesion release was planned for the patient. Conclusion: In cases of post-traumatic arthritis with severe stiffness, total knee arthroplasty is a viable option in providing good pain relief with excellent functional improvement; however, the procedure is technically more demanding.