Outcome of Monolateral Rail Fixator in Infected Nonunion of Femur Diaphysis Developing After Intramedullary Fixation

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2022 May 11

PMID 35543884

Authors

Rajesh Rohilla

Pankaj Kumar Sharma

Mohit Dua

Roop Singh

Deepshikha Beniwal

Arya Khokhar

Affiliations

Soon will be listed here.

Abstract

Introduction: Consensus is lacking regarding management of posttraumatic infected diaphyseal nonunions of femur following intramedullary nailing. Present study reports outcomes of single stage standardised treatment protocol using monolateral rail external fixator/limb reconstruction system in this type of infected diaphyseal femoral nonunions.

Methods: This retrospective study included 26 patients with mean age of 31.7 years having posttraumatic infected diaphyseal femoral nonunions following intramedullary nailing and managed with radical debridement and monolateral rail fixator. The results were assessed by Association for the Study and Application of the Method of Ilizarov criteria.

Results: Mean intraoperative bone gap was 4.34 (range, 2-7) cm. Mean gain in bone length was 4.04 (range, 0-7) cm. Fracture united primarily in 22 cases and after freshening of edges, fixator adjustment and fibular grafting in three more patients. Infection persisted in one patient. Most common complications were superficial pin tract infection (15 patients) and loss of more than 30° knee flexion (13 patients). The bone results were excellent, good, and poor in 15, 9, and 2 patients, respectively. The functional results were excellent, good, fair, and poor in 11,13,1 and 1 patient, respectively.

Conclusion: Single stage procedure including radical debridement, acute docking, distraction osteogenesis at corticotomy site and stabilization with monolateral rail fixator reliably achieves good to excellent bone and functional results, union and eradication of infection in majority of infected nonunions of femoral diaphysis developing after intramedullary fixation. We recommend acute docking in bone gap ≤ 5 cm.

Citing Articles

Management of Distal Femoral Non-union: A Systematic Review.

Migliorini F, Schafer L, Simeone F, Vaish A, Bhadani J, Vaishya R Indian J Orthop. 2024; 58(12):1686-1723.

PMID: 39664354 PMC: 11628467. DOI: 10.1007/s43465-024-01205-4.

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