Simultaneous transarticular intramedullary nailing of the tibia and total knee replacement in tibial nonunion and osteoarthrosis

The combined manifestation of a nonunion of the proximal tibia and an osteo arthrosis of both knee joints is not very common. Yet, this was a kind of " unhappy triad" for a 86 year old lady suffering from a nonunion after one y ear of conservative treatment of a proximal tibial shaft fracture. Her qual ity of life has already been reduced by a loss of visual power and she was completely invalidized. She was unable to walk and she was hospialized for the whole period of time. The operative treatment consisted in an intramedu llary tibial nailing through the resected tibial joint surface using an IMS C-nail and, simultaneously through the same surgical approach, in a partial ly cemented total knee joint replacement. After 5 months a replacement of t he second knee joint also was performed and 6 weeks later the almost blind patient could be discharged for home again. After another 7 months a proxim al femoral fracture of the first side was repaired using a proximal femural nail. Four years later she still is able to live on her own and runs her f lat with only little extern help. She can walk as far as 3 km and enjoys a good knee function.