Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb prepared for a retrograde intramedullary nailing procedure.

Anatomical surgical approach:  A longitudinal incision was made over the distal femur, followed by careful dissection to expose the pseudoarthrosis site. Radical debridement was performed to remove all non-viable bone tissue. A retrograde femoral nail was inserted through the intercondylar notch, and a medial bone substitute was placed. A turbo membrane was applied to initiate the first stage of the Masquelet technique.

The surgeon noted that the debridement was extensive due to significant non-viable bone tissue. The retrograde nail provided adequate stabilization, and the application of the turbo membrane was achieved without complications. The surgeon emphasized the importance of meticulous debridement to prevent recurrence of pseudoarthrosis.

Postoperative protocol:   Postoperatively, the patient commenced walking training with partial weight-bearing as tolerated, focusing on muscle mass gain to support rehabilitation.

Follow up:   Not specified.

Orthopaedic implants used:   Retrograde femoral nail, medial bone substitute, turbo membrane, medial plate, lateral titanium mesh.