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[The monorail system--bone segment transport over unreamed interlocking nails]

G Oedekoven1, D Jansen, M Raschke

  • 1Chirurgische Klinik und Poliklinik, Technischen Universität, Klinikum rechts der Isar, München.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|November 1, 1996
PubMed
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This study shows a novel monorail system for bone defect treatment, achieving healing in all patients. It offers an alternative to the Ilizarov method for select cases without infection.

Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Regenerative Medicine

Background:

  • Segmental bone defects pose significant challenges in orthopedic treatment.
  • Traditional methods like the Ilizarov apparatus have limitations.
  • The need for alternative, effective bone transport techniques is critical.

Purpose of the Study:

  • To demonstrate a novel treatment protocol using AO external fixation and an interlocking nail (monorail system) for segmental bone defects.
  • To evaluate the efficacy and outcomes of this monorail system in a patient cohort.
  • To establish criteria for patient selection for this technique.

Main Methods:

  • Osteotomy of the bone defect followed by segmental transport using an anteromedial (tibia) or lateral (femur) AO external fixator over an unreamed interlocking nail.

Related Experiment Videos

  • Application of the monorail system in 20 patients with tibial (13) and femoral (3) defects, leg-length discrepancies (3), and femoral non-union (1).
  • Analysis of defect size (5-18.5 cm) and bone transport duration (19.42 days/cm for tibia, 15.93 days/cm for femur).

    • Main Results:

    • All 20 patients achieved bone healing, with no required amputations.
    • Two patients experienced deep infections, necessitating a switch to the Ilizarov apparatus.
    • The monorail system demonstrated feasibility for treating various bone defect sizes and locations.

    Conclusions:

    • The monorail system, combined with AO external fixation and an interlocking nail, is a viable alternative for treating segmental bone defects.
    • Successful outcomes were achieved in all patients, highlighting the system's effectiveness.
    • Patient selection criteria, particularly regarding infection and soft-tissue status, are crucial for optimal results, as outlined by an accompanying algorithm.