Adjustment of traumatic femur shortening assisted by an intramedullar skeletal kinetic distractor: a case report

INTRODUCTION: Distal comminuted femoral fractures with joint involvement are highly challenging for the surgeon. We present a potential therapeutic concept that aims especially at the treatment of posttraumatic leg length discrepancy. CASE PRESENTATION: This case report describes a polytraumatized 19-year-old German woman. Among other injuries she had a third grade open distal comminuted femoral fracture with a long distance metaphyseal osseous defect. As a primary care procedure an external fixation was applied at first. On day 13, an open reconstruction of her distal femur and the articular surface was performed by screw osteosynthesis, shortening and intramedullary nailing. Due to delayed osseous consolidation an autologous cancellous bone grafting was performed twice. In addition to the second cancellous bone graft an allogeneic cortical bone graft was implemented. A 6.5cm posttraumatic leg length shortening after osseous consolidation was the result. The entire leg length shortening was successfully treated 16 months after her accident with the help of an intramedullar skeletal kinetic distractor. CONCLUSIONS: With the help of the current case report of a patient with polytrauma and a third grade open distal comminuted femoral fracture with joint involvement and a long distance osseous defect, we present a potential therapeutic concept that aims especially at the treatment of posttraumatic leg length discrepancy.