Supracondylar Femur Nonunion Associated With Previous Vascular Repair

Importance of Vascular Exam in Preoperative Planning of Nonunion Repair

Abstract

One case of a Gustilo type 3C open OTA 33A-1 supracondylar femur fracture with superficial femoral artery injury that underwent reverse saphenous vein graft repair and open reduction and internal fixation with a retrograde femoral nail is reviewed. The fracture progressed to a hypertrophic nonunion despite 2 bone-grafting procedures and a nail dynamization. Upon referral for revision of the nonunion, a vascular examination revealed a well-perfused extremity with slightly diminished pedal pulses. An arteriogram was ordered that revealed an intraosseous aneurysm associated with the nonunion site and vascular repair. In a joint procedure with vascular and orthopedic surgeons, the previous vessel repair was mobilized, the aneurysmal feeder vessels were ligated, and the nonunion was revised with bridge plating and iliac crest autograft. The nonunion healed uneventfully, and the patient shows no signs of vascular compromise at the 2-year follow-up. The importance of the preoperative vascular assessment is emphasized, and the literature is reviewed.