Reconstruction of juxta-articular huge defects of distal femur with vascularized fibular bone graft and Ilizarov's distraction osteogenesis.
BACKGROUND
We evaluate the effect of reconstructing huge defects (mean, 15.8 cm) of the distal femur with Ilizarov's distraction osteogenesis and free twin-barreled vascularized fibular bone graft (TVFG).


METHODS
We retrospectively reviewed a consecutive series of five patients who had cases of distal femoral fractures with huge defects and infection that were treated by the Ilizarov's distraction osteogenesis. After radical debridement, two of the five cases had free TVFG and monolocal distraction osteogenesis, and another two cases had multilocal distraction osteogenesis with knee fusion because of loss of the joint congruity. The other case with floating knee injury had bilocal distraction osteogenesis and a preserved knee joint. The mean defect of distal femur was 15.8 cm (range, 14-18 cm) in length.


RESULTS
The mean length of distraction osteogenesis by Ilizarov's apparatus was 8.2 cm. The mean length of TVFG was 8 cm. The average duration from application of Ilizarov's apparatus to achievement of bony union was 10.2 months (range, 8-13 months). At the end of the follow-up, ranges of motion of three knees were 0 to 45 degrees, 0 to 60 degrees, and 0 to 90 degrees. Two cases had knee arthrodesis with bony fusion because of loss of the joint congruity. There were no leg length discrepancies in all five patients. In addition, three patients had pin tract infections and one case had a 10 degree varus deformity of the femur.


CONCLUSIONS
Juxta-articular huge defect (>10 cm) of distal femur remains a challenge to orthopedic surgeons. Ilizarov's technique provides the capability to maintain stability, eradicate infection, restore leg length, and to perform adjuvant reconstructive procedure easily. In this study, we found that combining Ilizarov's distraction osteogenesis with TVFG results in improved patient outcome for patients with injuries such as supracondylar or intercondylar infected fractures or nonunion of distal femur with huge bone defect.
Lai
Davy
D
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, and Division of Orthopedics, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan. davylai2002@yahoo.com.tw
Chen
Chuan-Mu
CM
Chiu
Fang-Yao
FY
Chang
Ming-Chau
MC
Chen
Tain-Hsiung
TH
D000293:Adolescent; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D005599:Fractures, Ununited / Q000382:microbiology / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D018919:Neovascularization, Physiologic; D019857:Osteogenesis, Distraction; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies