Following Multiple Failed Reconstructions of a Distal Femur Fracture, Osseous Union Achieved After Superficial Femoral Artery Endarterectomy.

Abstract

Background: Nonunion of a distal femur fracture is a serious complication in which bone healing ceases or fails to resolve, often necessitating further surgical intervention. Poor blood supply and unstable fixation have been identified as contributing factors to osseous nonunion. In this case, we highlight a challenging femur fracture that achieved osseous union only after resolution of a superficial femoral artery occlusion via endarterectomy that improved blood flow to the fracture site.

Case report: A 54-year-old male was involved in a high-speed motor vehicle accident that resulted in a left distal femur fracture. The patient underwent multiple reconstructive procedures that were complicated by hardware failure and recurrent nonunion. Prior to the sixth reconstruction, a superficial femoral artery occlusion was discovered and addressed with endarterectomy. The sixth and final procedure resulted in osseous union and stable fixation of the femur fracture.

Conclusion: A missed superficial femoral artery occlusion likely contributed to the delay in achieving osseous union of a traumatic comminuted distal femur fracture.