title: Distraction osteogenesis using a monolateral external fixator for infected non-union of the femur with bone loss.
abstract: OBJECTIVE
  To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union of the femoral shaft.
  
  
  METHODS
  13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed.
  
  
  RESULTS
  The patients had undergone a mean of 2.9 (range, 1-7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6-18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5-17) cm. The mean treatment duration was 7.3 (range, 5-15) months. The mean lengthening index was 12.3 (range, 11.5-15) days/cm. The mean treatment index was 27.9 (range, 24-40) days/cm. The mean follow-up duration was 19.3 (range, 15-41) months. Functional outcome was excellent in 5, good in 8, and fair in 2 patients. All patients achieved bone union and eradication of infection. Bone healing was excellent in 12 and good in 3 patients. All the patients were satisfied with the procedure. None had neurovascular complications, joint subluxations, or refracture of the regenerated bone. True complications encountered included knee stiffness (n=6) and knee flexion contracture (n=1). Three patients with an initial bone defect of >10 cm had delayed union and underwent bone grafting.
  
  
  CONCLUSIONS
  Bone transport using a monolateral external fixator is safe and effective for treating infected non-union of the femoral shaft.
authors.affiliation: Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India. mamc_309@yahoo.co.in
authors.forename: Sumit
authors.initials: S
authors.lastname: Arora
authors.forename: Sumit
authors.initials: S
authors.lastname: Batra
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Aman
authors.initials: A
authors.lastname: Goyal
mesh_terms: D000293:Adolescent; D000328:Adult; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000295:instrumentation*; D012189:Retrospective Studies; D055815:Young Adult