Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

Abstract

Purpose The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail. Methods Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery. Results Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00. Conclusion Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients’ quality of life to a level comparable with the normal population.

A modified hybrid transport technique combined with a retrograde tibiotalocalcaneal arthrodesis nail for the management of distal tibial periarticular osteomyelitis and associated defects

“…Lu et al evaluated results of post-traumatic femoral defects treated by single-armed external fixator over an intramedullary nail. Eight patients were included and the mean external fixator index was 23.88 days/cm [ 25 ]. Oh et al reported that the mean external fixation index was 26 days/cm using hybrid transport for reconstruction of long bone defects in tibia [ 26 ].…”

“…Therefore, our MHT was more efficacious for controlling infection, which could also decrease unplanned surgeries due. In Lu’s study, two patients had infection recurrence after adopting hybrid transport technique [ 25 ]. Bas et al reported four patients of 40 suffered from infection recurrence as postoperative complications [ 29 ].…”

Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A case report

“…Limb-lengthening utilising distraction osteogenesis with external fixators began with the Ilizarov technique, and evolved to include limb lengthening over an intramedullary nail [4] . However external fixators are inherently cumbersome, and are associated with complications like pin site infections, knee stiffness, and docking site non-union [5] .…”

New insights in lower limb reconstruction strategies

“…46,50 Recently, the adoption of a contemporary use of internal and external fixations in the same patient is gaining popularity, thanks also to the reported reduction in time of use of the external fixator. [51][52][53] Particularly, Kadhim et al, 54 in their Systematic review, reported that the combined use of circular fixation and intramedullary nail provided the highest success rate for the treatment of tibial nonunion with segmental bone defect.…”