Abstract
Introduction A review of the treatment of distal femoral non-union and mal-union by intra-articular osteotomy is presented.
Methods It is based on a review of the literature and personal experience.
Results Articular fractures are of three basic types: split wedge fractures, split wedge depression and pure depression. Intra-articular osteotomies are easiest for pure split wedge fractures which have gone on to a mal-union because one can quite easily identify the original fracture line and then recreate it surgically at operation. Any callus which has formed during healing can also be resected to make the fragments fit. Corrective osteotomies are still possible, although more difficult, for split wedge fractures combined with joint depression, the so called split wedge depression type of fractures, which have mal-united. However, pure depression intra-articular fractures which have gone on to union cannot be reconstructed by means of an intra-articular osteotomy because it is impossible to recreate the original fracture lines. This fact emphasizes the importance of reducing and stabilizing intra-articular fractures as early as possible because of their rapid union and subsequent difficulties if one tries to correct the mal-unions. Post-traumatic arthritis develops as result of damage to the articular cartilage at the time of the trauma, as result of joint incongruity, axial deformity and resultant joint overload, and joint instability. Joint incongruity and axial deformity result in post-traumatic arthritis because of increase in stress beyond the tolerance of articular cartilage. Stress is the result of force distributed over available surface area S= F/A. Joint incongruity decreases available surface area and increases stress. Axial deformity because of overload increases force which increases stress. Instability on the other hand results in shearing forces which lead to rapid articular cartilage destruction. Instability is more malignant for a joint then excessive stress and leads more rapidly to joint destruction.
Conclusions From the above it is evident that the objectives in treatment of an intra-articular ma-lunion and non-union is to: Restore joint congruency and normal anatomy, correct axial malalignment, restore joint stability and restore joint mobility.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
