Osteosynthesis and Trauma Care 2004; 12(2): 57-61
DOI: 10.1055/s-2004-822769
Original Article

© Georg Thieme Verlag Stuttgart · New York

Salvage of Nonunion and Infection about the Knee Following Failed Fracture Fixation

N. Karandikar1 , A. L. Malkani1
  • 1Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
Further Information

Publication History

Publication Date:
05 July 2004 (online)


Failed fracture fixation about the knee due to nonunion combined with infection is a difficult and challenging problem to treat. Concerns at the time of treatment include persistent infection, nonunion, deformity, bone loss, compromised soft tissues, and ligamentous instability. The primary objective in treatment includes eradication of infection followed by a staged reconstruction procedure which involves a complex total knee arthroplasty.


  • 1 Ali A M, El-Shafie M, Willett K M. et al . Failure of fixation of tibial plateau fractures.  J Orthop Trauma. 2002;  16 323-329
  • 2 Bolhofner B, Carmen B, Clifford P. et al . The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique.  J Orthop Trauma. 1996;  10 372-377
  • 3 Buckwalter-Einhorn T A, Bolander M E, Cruess R L. et al .Healing of the Musculoskeletal Tissues. In: Rockwood C, Green D (eds). Fractures in Adults. JB Lippincott, Philadelphia 1996; 1972-2000
  • 4 Farrell M J, Bryan R S. Total knee arthroplasty after septic arthritis.  Orthop Clinic N Am. 1975;  6 1057
  • 5 Freedman E L, Hak D J, Johnson E E. et al . Total knee replacement including a modular distal femoral component in elderly patients with acute fracture or non-union.  J Orthop Trauma. 1995;  9 231-237
  • 6 Goldman R T, Scuderi G R, Insall J N. 2-stage reimplantation for infected total knee replacement.  Clin Orthop Rel Res. 1996;  331 118-124
  • 7 Lee G C, Pagnano M W, Hanssen A D. Total knee arthroplasty after prior bone or joint sepsis about the knee.  Clin Orthop Rel Res. 2002;  404 226-231
  • 8 Lonner J H, Pedlow F X, Siliski J M. Total knee arthroplasty for post traumatic arthrosis.  J Arthroplasty. 1999;  14 969-975
  • 9 Roffi R P, Merritt P O. Total knee replacement after fractures about the knee.  Orthop Rev. 1990;  19 614-620
  • 10 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975.  Clin Orthop Rel Res. 1979;  138 94-104
  • 11 Weiss N G, Parvizi J. Total knee arthroplasty in patients with a prior fracture of the tibial plateau.  J Bone Joint Surg [Am]. 2003;  85 218-221

Arthur L. MalkaniMD, Associate Professor 

Department of Orthopaedic Surgery · University of Louisville

210 East Gray Street, Suite 1003

Louisville, KY 40202

Phone: Phone: 1/5 02-8 52-69 64

Fax: 1/5 02-8 52-72 27

Email: art.malkani@louisville.edu

Email: klmaye01@gwise.louisville.edu