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'Rail and Nail' bifocal management of atrophic femoral nonunion.

Abstract Aims The management of a significant bony defect following excision of a diaphyseal atrophic femoral nonunion remains a challenge. We present the outcomes using a combined technique of acute femoral shortening, stabilized with a long retrograde intramedullary nail, accompanied by bifocal osteotomy compression and distraction osteogenesis with a temporary monolateral fixator. Patients and Methods Eight men and two women underwent the 'rail and nail' technique between 2008 and 2016. Proximal locking of the nail and removal of the external fixator was undertaken once the length of the femur had been restored and prior to full consolidation of the regenerate. Results The mean lengthening was 7 cm (3 to 11). The external fixator was removed at a mean of 127 days (57 to 220). The mean bone healing index was 28 days/cm and the mean external fixation index was 20 days/cm (11 to 18). There were no superficial or deep infections. Conclusion This small retrospective study shows encouraging results for a combined technique, enabling compression of the femoral osteotomy, alignment, and controlled lengthening. Removal of the fixator and proximal locking of the nail reduces the risk of complications and stabilizes the femur with the maximum working length of the nail. Cite this article: Bone Joint J 2018;100-B:634-9.
PMID
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Authors

Mayor MeshTerms
Keywords

Bifocal treatment

Bone lengthening

Distraction osteogenesis

Femoral nonunion

Segmental defect

Journal Title the bone & joint journal
Publication Year Start




PMID- 29701097
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 5
DP  - 2018 May 1
TI  - 'Rail and Nail' bifocal management of atrophic femoral nonunion.
PG  - 634-639
LID - 10.1302/0301-620X.100B5.BJJ-2017-1052.R1 [doi]
AB  - Aims The management of a significant bony defect following excision of a
      diaphyseal atrophic femoral nonunion remains a challenge. We present the outcomes
      using a combined technique of acute femoral shortening, stabilized with a long
      retrograde intramedullary nail, accompanied by bifocal osteotomy compression and 
      distraction osteogenesis with a temporary monolateral fixator. Patients and
      Methods Eight men and two women underwent the 'rail and nail' technique between
      2008 and 2016. Proximal locking of the nail and removal of the external fixator
      was undertaken once the length of the femur had been restored and prior to full
      consolidation of the regenerate. Results The mean lengthening was 7 cm (3 to 11).
      The external fixator was removed at a mean of 127 days (57 to 220). The mean bone
      healing index was 28 days/cm and the mean external fixation index was 20 days/cm 
      (11 to 18). There were no superficial or deep infections. Conclusion This small
      retrospective study shows encouraging results for a combined technique, enabling 
      compression of the femoral osteotomy, alignment, and controlled lengthening.
      Removal of the fixator and proximal locking of the nail reduces the risk of
      complications and stabilizes the femur with the maximum working length of the
      nail. Cite this article: Bone Joint J 2018;100-B:634-9.
FAU - Davda, K
AU  - Davda K
AD  - Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK.
FAU - Heidari, N
AU  - Heidari N
AD  - The Royal London Hospital, Whitechapel, London, UK.
FAU - Calder, P
AU  - Calder P
AD  - Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK.
FAU - Goodier, D
AU  - Goodier D
AD  - Limb Reconstruction Unit, Royal National Orthopaedic Hospital, London, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Atrophy/pathology/surgery
MH  - Bone Nails
MH  - Bone Regeneration
MH  - External Fixators
MH  - Female
MH  - Femoral Fractures/physiopathology/*surgery
MH  - Femur/pathology/physiopathology/*surgery
MH  - Fractures, Ununited/*surgery
MH  - Humans
MH  - Leg Length Inequality/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Procedures/adverse effects/instrumentation/methods
MH  - Osteogenesis, Distraction
MH  - Osteotomy
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Bifocal treatment
OT  - Bone lengthening
OT  - Distraction osteogenesis
OT  - Femoral nonunion
OT  - Segmental defect
EDAT- 2018/04/28 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/04/28 06:00
PHST- 2018/04/28 06:00 [entrez]
PHST- 2018/04/28 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1302/0301-620X.100B5.BJJ-2017-1052.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 May 1;100-B(5):634-639. doi:
      10.1302/0301-620X.100B5.BJJ-2017-1052.R1.