case_images: PMC4811065_01
case_images: Preoperative radiographs showing an unconsolidated distal femoral shaft fracture with the rupture of one of the distal screws.
case_images: CRIOR2016-5125861.001.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.001.jpg
case_images: fig1
case_images: The radiographic examination showed a hypertrophic nonunion of the distal femur (Figure 1), refractory to the conservative treatment, which has been given an indication for surgical treatment.
case_images: Grafting of the corticoperiosteal flap. Black arrow: femoral artery; blue arrow: descending genicular artery (drawing by G. Ferri).
case_images: CRIOR2016-5125861.002.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.002.jpg
case_images: fig2
case_images: The vastus medialis was reflected anteriorly, whereas the tendon of the adductor longus was retracted posteriorly, exposing the medial femoral condyle and its periosteal blood supply (Figure 2). Then, using an osteotome or an oscillating saw, the outer cortex was cut and lifted, hammering slightly from the periphery towards the center (Figures 2 and 3).
case_images: Intraoperative image of the corticoperiosteal graft.
case_images: CRIOR2016-5125861.003.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.003.jpg
case_images: fig3
case_images: Then, using an osteotome or an oscillating saw, the outer cortex was cut and lifted, hammering slightly from the periphery towards the center (Figures 2 and 3).
case_images: Overturning of the corticoperiosteal flap (drawing by G. Ferri).
case_images: CRIOR2016-5125861.004.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.004.jpg
case_images: fig4
case_images: The fracture was reduced and the osteosynthesis was performed by an anterograde intramedullary nail; the graft was overturned and wrapped around the nonunion and fixed with transbone stitches (Figure 4).
case_images: The femoral shaft fracture was stabilized with retrograde intramedullary nailing and the bone loss was restored with a corticoperiosteal pedicled flap. The X-ray shows less radiopacity of the flap (dotted line).
case_images: CRIOR2016-5125861.005.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.005.jpg
case_images: fig5
case_images: A radiograph was performed at the end of the procedure (Figure 5).
case_images: At 20 months of follow-up, the radiographic examination showed the complete healing of the femoral shaft nonunion.
case_images: CRIOR2016-5125861.006.jpg
case_images: PMC4811065_01_CRIOR2016-5125861.006.jpg
case_images: fig6
case_images: The radiographs showed complete union of the distal femur (Figure 6).