Surgical management of critical femoral bone loss by bone transport over intramedullary nail by monorail system: a case report
Keywords:Femoral bone loss, Primary plating, Bone transport over l M nail, Monorail system
Present case report is about a male patient who met with a road traffic accident sustained an open crush, contaminated, injury of lower end femur of right side with significant loss of lower thigh bone (8 cm). He had fracture of inter condylar femur with fracture upper end tibia and lower third tibia with impending vascular insufficiency of leg and foot. Operated after correction of anaemia by debridement, fixation of femur with plate and inter condylar screw. Upper end tibia and Lower half tibia were fixed with separate plates and fasciotomy of leg. After 2 months femoral plate was replaced with intramedullary locking nail and superadded with monorail fixator. Corticotomy at proximal femur for bone transportation. Bone gap was corrected within 4 months and bone grafting was done at distal docking site. Union achieved and fixator removed after 4 months of this. Patient showed good results till last follow up 28 months, having good range of motion of knee.so critical bone loss at femur was treated by distraction osteogenesis over intramedullary nail with monorail external fixator system.
Keating JF, Simpson A.H.R.W, Robinson CM. The management of fractures with bone loss. J Bone Joint Surg. 2005;87:142-50.
Pauls pipitone DO, Rehman S. Management of traumatic bone loss in lower limbs. Orthop Clin N Am. 2014;45:469-82.
Kumar R, Mohapatra SS, Joshi N, Goyal SK, Kumar K, Gora R. Primary Ilizarov external fixation in open grade III type C distal femur fractures: Our experience. J Clin Orthop Trauma. 2019;10:928-33.
Baruah RK, Kumar S. Ilizarov strategies in the management of non-unions and difficult fractures of the femur. Jlimblenthrecon. 2019;5(2):79-87.
Krishnan A, Pamecha C, Patwa JJ. Modified Ilizarov technique for infected nonunion of the femur: The principle of distraction-compression osteogenesis. J Orthop Surg (Hong Kong). 2006;14:265-72.
Arazi M, Memik R, Ogün TC, Yel M. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg Br. 2001;83:663-7.
Li G, Berven S, Athansou NA, Simpson AH. Bone transport over an intramedullarynail: a case report with histologic examination of the regenerated segment. Injury.1999;30:525:34-41.
Paley D, Herzenberg JE, Paremain G, Bhave A. Femoral lengthening over an intramedullary nail: a matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg. 1997;79-A:1464-80.
Zhang Q, Zhang W, Zhang Z, Zhang L, Chen H, Hao M et al. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res. 2017;12:183.
Shukla R, Jain A, Jain RK. Long-term study of functional outcomes of floating knee injuries. J Orthop Traumatol Rehabil 2020;12:23-30.