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Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss
Sumit Arora1, Sumit Batra, Vikas Gupta
1Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India. mamc_309@yahoo.co.in
Purpose:
To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union 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.
Insights
Distraction osteogenesis with a monolateral external fixator effectively treats infected non-union of the femoral shaft. This bone transport method achieved union and eradicated infection in all patients, ensuring satisfactory outcomes.
Area of Science:
- Orthopedic surgery
- Trauma reconstruction
- Bone regeneration
Background:
- Infected non-union of the femoral shaft presents a significant challenge in orthopedic reconstruction.
- Bone loss, often exceeding 5 cm, complicates treatment and necessitates advanced techniques.
Purpose of the Study:
- To evaluate the safety and efficacy of distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union of the femoral shaft.
- To assess outcomes including bone healing, infection eradication, functional status, and complications.
Main Methods:
- Retrospective review of 15 patients (13 male, 2 female) with infected non-union of the femoral shaft and bone defects >5 cm.
- Patients underwent debridement, bone resection, and subsequent bone transport with a monolateral external fixator.
- Assessment included lengthening index, radiographic consolidation, functional outcomes, and complications.
Main Results:
- All 15 patients achieved bone union and eradication of infection, with excellent or good bone healing in all cases.
- Functional outcomes were rated as excellent (5), good (8), or fair (2).
- No neurovascular complications, joint subluxations, or refractures occurred; common issues were knee stiffness (6 patients) and flexion contracture (1 patient).
Conclusions:
- Distraction osteogenesis via monolateral external fixator is a safe and effective treatment for infected femoral shaft non-union with bone loss.
- The technique demonstrates high rates of bone union, infection control, and patient satisfaction.
- While effective, potential complications like joint stiffness should be monitored and managed.
