Abstract
Purpose.
To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected nonunion of the femoral shaft.
Methods.
13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed.
Results.
The patients had undergone a mean of 2.9 (range, 1–7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6–18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5–17) cm. The mean treatment duration was 7.3 (range, 5–15) months. The mean lengthening index was 12.3 (range, 11.5–15) days/cm. The mean treatment index was 27.9 (range, 24–40) days/cm. The mean follow-up duration was 19.3 (range, 15–41) months. Functional outcome was excellent in 5, good in 8, and fair in 2 patients. All patients achieved bone union and eradication of infection. Bone healing was excellent in 12 and good in 3 patients. All the patients were satisfied with the procedure. None had neurovascular complications, joint subluxations, or refracture of the regenerated bone. True complications encountered included knee stiffness (n=6) and knee flexion contracture (n=1). Three patients with an initial bone defect of >10 cm had delayed union and underwent bone grafting.
Conclusion.
Bone transport using a monolateral external fixator is safe and effective for treating infected non-union of the femoral shaft.