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Management of femoral shaft infected nonunion through customised Ilizarov external fixator assembly in a morbidly obese patient
  1. Muhammad Saad Ilyas1,
  2. Abdul Sattar1,
  3. Uruj Zehra2 and
  4. Amer Aziz1
  1. 1Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
  2. 2Department of Anatomy, University of Health Sciences, Lahore, Pakistan
  1. Correspondence to Professor Amer Aziz; spinedoc1956{at}


A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°–20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases.

  • orthopaedics
  • disability

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  • Contributors MSI attended the patient, planned and performed surgery, followed-up the patient and contributed in the writing. AS helped in the management and planning of surgery and in revising the final manuscript. UZ performed background literature research on the topic, wrote the manuscript and revised the final draft. AA supervised the whole case and provided expertise at every step of management and in writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.