title: Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study.
abstract: BACKGROUND
  Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods.
  
  
  METHODS
  Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups.
  
  
  RESULTS
  Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey.
  
  
  CONCLUSIONS
  Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.
authors: Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410007, Hunan, People's Republic of China. amiba3000@163.com
authors: Jun
authors: J
authors: Wan
authors: Lin
authors: L
authors: Ling
authors: Xiang-sheng
authors: XS
authors: Zhang
authors: Zhi-hong
authors: ZH
authors: Li
mesh_terms: D000328:Adult; D001858:Bone Nails; D002681:China; D057186:Comparative Effectiveness Research; D016267:External Fixators; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique / Q000706:statistics & numerical data*; D016268:Internal Fixators; D008297:Male; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D011795:Surveys and Questionnaires