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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

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Early Post-Traumatic Van Nes Rotationplasty After an Open Femur Fracture With a Necrotizing Soft-Tissue Infection: A

Erik Y Tye¹, Adam J Taylor, Kristen Combs

¹Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, California.

JBJS Case Connector

|November 4, 2021

Summary

This summary is machine-generated.

Van Nes rotationplasty (VNR) offers a successful limb-salvage solution for complex open femur fractures with necrotizing soft-tissue infection (NSTI). This approach can help patients avoid more extensive amputations and regain mobility.

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Area of Science:

Orthopedic Surgery
Trauma Surgery
Limb Reconstruction

Background:

Open femur fractures, particularly Type IIIA, present significant challenges due to bone loss and infection risk.
Necrotizing soft-tissue infection (NSTI) is a severe complication that can compromise limb viability and necessitate amputation.
Previous limb-preserving attempts, including advanced intramedullary nailing and free flap surgery, were unsuccessful in this case.

Observation:

A 26-year-old male sustained a Type IIIA open femur fracture in a pedestrian accident.
The fracture was complicated by NSTI and substantial bone loss.
Multiple surgical interventions failed to preserve the limb adequately.

Findings:

Definitive treatment was achieved using a Van Nes rotationplasty (VNR).
The patient successfully ambulated independently with a prosthesis post-VNR.
No recurrent infection was observed at 3-year follow-up.

Implications:

Van Nes rotationplasty (VNR) is a viable alternative to transfemoral amputation or hip disarticulation in complex open femur fractures with NSTI.
VNR can lead to successful functional limb preservation and improved patient mobility.
This case highlights the potential of VNR in managing challenging trauma cases with severe soft-tissue compromise and bone defects.