Distal femur arthroplasty for non-union distal femur fracture with failed osteosynthesis in osteoporotic octogenarian: a case report with literature review

Distal femur fractures (DFF) in the elderly have high morbidity and management challenges. The low energy trauma commonly presents significant fracture comminution, osteoporosis, pre-existing knee arthritis, co-morbid medical conditions affecting the union, weight-bearing potential and rehabilitation with profound functional disability. An octogenarian presented with a failed osteosynthesis resulting in non-union of a distal femur fracture compounded by osteoporosis and knee arthritis. He had been non-ambulatory with a painful, deformed knee. Management with a single-stage removal of the distal femur locked plate constructs and the defect reconstruction with the distal femur arthroplasty (DFA). The outcome was a pain-free weight-bearing mobilization with a functional range of knee motion. The surgical management in the elderly for the displaced intra-articular distal femur fractures is to restore the limb length and articular congruence for a functional knee. Fixation with either a distal femur locking plate or an intramedullary nail has a propensity for non-union, malunion, knee stiffness, and failed fixation. Salvage procedure gives good functional outcomes in failed osteosynthesis with DFA. The arthroplasty allows an immediate pain-less weight-bearing potential with improved ambulatory status and quality of life. The single-stage procedure in the elderly can regain a stable, functional knee joint.