Bone Transport with a Unilateral External Fixator for Femoral Infected Nonunion After Intramedullary Nailing Fixation: A Case Control Study

This is a therapeutic study to evaluate the results of femoral infected nonunion using bone transport with an external fixator after debridement and irrigation. We retrospectively reviewed 15 patients with femoral infected nonunion after intramedullary nailing fixation of fractures from October 1999 to January 2010 in our institute. There were 7 males and 8 females with an average age of 32.5 years. First, the infection was eradicated completely, and the medullary canals were continuous irrigated for 2-3 weeks. After eradicating the infection tissues, the mean amount of bone defect was 8.7 cm (range, 4.0-16.0 cm). The unilateral consecutive distraction-compression osteosynthesis technique was applied after long-time medullary cavity-wound exclusion surgery. Enumeration data was described by frequency and measurement data by mean. Bone infections were controlled in all patients except 1 patient after the first debridement and irrigation. All patients have achieved bony union without recurrence of infection during the follow-up period, the mean external fixation index was 43.4 day/cm. According to the criteria recommended by Paley, the bone results were graded as excellent in 13 (86.7%) cases and good in 2 (13.3%) cases; the functional results were graded as excellent in 6 (40.0%) cases, good in 6 (40.0%) cases and fair in 3 (20.0%) cases. In management of femoral infectious nonunion which caused by intramedullary nailing fixation, the surgery of consecutive compression-distraction osteogenesis with unilateral external fixator achieves a highly effective treatment, and the method of debridement and irrigation is a compatible choice on the phase of infection-elimination.