case_images: PMC7276597_01
case_images: Clinical and radiographical situation at the patient's first appointment in September 2012 with applied Ilizarov ring fixator.
case_images: JOCR-9-74-g001.jpg
case_images: PMC7276597_01_JOCR-9-74-g001.jpg
case_images: F1
case_images: The patient preferred an exceptional salvage procedure to preserve the limb since amputation was not an option (Fig. 1).
case_images: X-ray showing a non-union of a femur fracture after removal of the Ilizarov ring fixator and rigorous surgical debridement, whereas an AO fixator external was applied for stabilization (a and b). A long gamma nail was implanted and crushed autologous cancellous bone from resected non-union bone tissue was applied in direct contact to the nail to cover bone defect (c and d).
case_images: JOCR-9-74-g002.jpg
case_images: PMC7276597_01_JOCR-9-74-g002.jpg
case_images: F2
case_images: Finally, an AO fixator external was implanted after several efficient debridements (Fig. 2a and b). A wide resection of the non-union tissue was performed which was crushed and placed beside the nail to bridge the defect zone (Fig. 2c and d).
case_images: X-rays 3 years after successful gamma nail implantation revealed new-formed bone at the side of applied crushed bone tissue (a and b). The patient was able to walk with full weight-bearing (c).
case_images: JOCR-9-74-g004.jpg
case_images: PMC7276597_01_JOCR-9-74-g004.jpg
case_images: F3
case_images: Femoral lengthening of 4 cm by a fully implantable motorized lengthening nail (Fitbone, Wittenstein and Ingersheim, Germany) a and b resulted in an equal length of leg without any sign of infection even 3 years after removal of the Fitbone c and d.
case_images: JOCR-9-74-g005.jpg
case_images: PMC7276597_01_JOCR-9-74-g005.jpg
case_images: F4
case_images: In addition, a varus supracondylar femur osteotomy was performed to correct for biomechanical alignment (Fig. 4a and b).