Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent table to facilitate access to the distal femur for retrograde nailing.

Anatomical surgical approach:  A longitudinal incision was made over the distal femur, extending proximally as needed to access the pseudoarthrosis site. Subperiosteal dissection was performed to expose the femoral shaft. The medullary canal was accessed distally for retrograde nailing, and thorough debridement of infected tissue was conducted. The canal was reamed using the RIA2 system.

The surgeon noted significant infection and necrotic tissue at the pseudoarthrosis site, necessitating extensive debridement. A cement spacer was placed to maintain limb length and alignment while delivering local antibiotics. The Masquelet technique was employed to promote future bone regeneration, with plans for staged reconstruction.

Postoperative protocol:   Postoperatively, the patient was instructed to remain non-weight bearing on the affected limb. A rehabilitation protocol focusing on range of motion exercises for adjacent joints was initiated, with gradual progression to partial weight-bearing as tolerated.

Follow up:   Not specified

Orthopaedic implants used:   Retrograde femoral nail, J&J RIA2 system, cement spacer, Masquelet membrane technique components.