Fig. 3
An 85-year-old male fell approximately 8.5 years following a left-sided total knee arthroplasty (and was also 9 years status-post left-sided hip fracture surgery). He sustained a supracondylar periprosthetic distal femur fracture and was surgically treated at a local hospital with a distal femur locking compression plate (LCP). He developed a nonunion and subsequently was treated with a bone stimulator. He presented to our institution 14 months following surgery. Anteroposterior (AP) and lateral imaging revealed a distal femur nonunion in varus deformity with posterior translation a flexion deformity (A, B). CT scan imaging further demonstrated the nonunion morphology (C). Revision open reduction and internal fixation (ORIF) was performed with LCP and screw removal, debridement of the nonunion site, (five) cultures taken, correction of deformity with placement of a 950 blade plate and screws, demineralized bone matrix and bone morphogenic protein-2 (D). He returned for routine follow-up and healed 10 months following ORIF. Most recent follow-up AP and lateral radiographs at 20 months (E, F) revealed a healed nonunion in acceptable alignment and with maintenance of fixation and resumed his activities of daily living