Femoral non-union above a fused knee: Successful treatment with exchange nailing and intramedullary delivery of bone morphogenetic protein

Abstract

Bone healing is a complex and well-orchestrated physiological process, in which bone repairs and regenerates regaining its original biomechanical and biochemical properties. It is estimated that 5 to 10% of all fractures are complicated by delayed union or non-union. Progression to non-union is thought to be multifactorial, even though the exact biological sequence remains obscure.Treatment should aim to addressing deficiencies in both the mechanical and biological components, along with eliminating co-factors that could negatively affect the locally induced fracture healing response.We report a case of a 78-year-old patient who presented with a distal femoral non-union above a previously fused knee, which was successfully managed with exchange nailing and intramedullary delivery of recombinant human bone morphogenetic protein-7 (rhBMP-7). Keywords: Femur, Non-union(s), Fused, BMP, Nail