title: Management of complex femoral nonunion with monorail external fixator: A prospective study.
abstract: OBJECTIVE
  To evaluate 30 patients who underwent distraction osteogenesis with monorail external fixator for complex femoral nonunion.
  
  
  METHODS
  Complex femoral nonunion includes infective non-union, gap nonunion, and limb-length discrepancy secondary to traumatic bone loss, which needs specialized treatment to ensure the functional integrity of femoral bone. 30 patients, including 28 male and 2 female (aged 22-62 years) patients, underwent surgical debridement followed by bone transport with monorail fixator. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles, and complications encountered during the treatment were assessed.
  
  
  RESULTS
  Patients underwent a mean of 2.2 (range 1-4) surgeries before presentation. The mean bone defect after surgical debridement was 5.83 cm (range 2-16 cm). The mean treatment duration was 204.7 days (range 113-543 days). The mean lengthening index was 13.06 days/cm with range from 12 to 16 days/cm. Mean maturation index was 23.51 days/cm with range from 17 to 45.5 days/cm. In our study, bone result was excellent in 17, good in 9, fair in 3, and poor in 1 patient. In our study functional outcome is excellent in 9 [30%], good in 14 [46.67%], fair in 5, and poor in 2 patients. In our study, we encountered 34 problems, 17 obstacles, and 8 complications.
  
  
  CONCLUSIONS
  We concluded that monorail external fixator is an effective treatment option for complex nonunion femoral shaft fracture and its functional outcome is comparable with any other treatment options. Lack of complications and its effectiveness makes monorail external fixator the treatment of choice for complex nonunion femoral shaft.
authors.affiliation: Senior Resident, Central Institute of Orthopaedics, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Hemendra Kumar
authors.initials: HK
authors.lastname: Agrawal
authors.affiliation: Senior Resident, Central Institute of Orthopedics, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Mohit
authors.initials: M
authors.lastname: Garg
authors.affiliation: Asstt. Professor, Central Institute of Orthopedics, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Balvinder
authors.initials: B
authors.lastname: Singh
authors.affiliation: Assoc. Professor, Central Institute of Orthopedics, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Jaiman
authors.affiliation: Consultant Orthopedic Surgeon, Newdelhi, India.
authors.forename: Vipin
authors.initials: V
authors.lastname: Khatkar
authors.affiliation: Addl. M.S. & Consultant Orthopedic Surgeon, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Shailender
authors.initials: S
authors.lastname: Khare
authors.affiliation: Senior Consultant, Orthopedics, Max Hospital, Newdelhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Batra
authors.affiliation: Director Professor, Ex-Head of Department, Central Institute of Orthopedics, VMMC & Safdarjung Hospital, Newdelhi, India.
authors.forename: Vinod Kumar
authors.initials: VK
authors.lastname: Sharma
keywords: External fixator; Femur; Ilizarov; Nonunion; Osteogenesis