Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

Abstract

Purpose: The rail fixator can improve the treatment outcome and provide good stability in patients with femoral bone transport. The purpose of this study is to investigate the clinical outcomes of bone transport using the Ilizarov technique by rail fixator in the treatment of femoral nonunion or bone defects caused by infection.

Methods: Clinical feature and treatment outcomes of 32 consecutive adult patients with femoral nonunion or bone defect caused by infection from January 2012 to January 2019 at a minimum of 2 years of follow-ups were retrospectively analyzed. Data were collected on participants' demographic details. All difficulties related to bone transport were documented according to Paley's classification. The clinical outcomes were evaluated using ASAMI criteria at the last clinical visit.

Results: All 32 patients with an average follow-up of 33.5 months. There were 17 problems, 21 obstacles, and 8 complications, and the complication rate per patient was 1.4. The main complications were pin-site infection (53.1%), axial deviation (21.9%), joint stiffness (18.8%), the delayed union of the docking site (18.8%), soft tissue incarceration(15.6%), delayed consolidation(6.3%), malunion(6.3%), and refracture (3.1%). All the patients achieved bone union, and no recurrence of infection was observed. The excellent and good rates of ASAMI bone and functional results were 87.5% and 81.3%, respectively.

Conclusion: Bone transport using the Ilizarov technique is an effective method for the treatment of femoral nonunion or bone defect caused by infection, and rail fixators have obtained satisfactory results in terms of bone and functional results.

Keywords: femur; ilizarov; infected nonunion; rail fixator system; systematic review.

Figure 1

PRISMA flow diagram.

Figure 2

A 42-year-old male patient with a left femur fracture caused by a traffic accident and post-traumatic osteomyelitis after external fixation. (A) Anteroposterior x-ray showed osteomyelitis of the middle femur; (B) Anteroposterior x-ray films on the day after radical debridement and installation of a rail fixator system showed a bone defect in the length of 10.2 cm; (C,D). Anteroposterior and lateral x-ray films 27 days after the operation, showed bone contact was reached; (E,F). Anteroposterior and lateral x-ray films at 13.6 months after the operation, showed good bony union and good regenerate consolidation; (G,H). Anteroposterior and lateral x-ray films show the good bony union and good regenerate consolidation at 12 months after the removal of external fixation. (I,J,K). Functional recovery at 12 months after the removal of external fixation.

Figure 3

A 39-year-old female patient with a right femur fracture caused by a fall accident and post-traumatic osteomyelitis after plate internal fixation. (A) Anteroposterior x-ray showed osteomyelitis of the femur; (B) Anteroposterior x-ray films on the day after radical debridement and installation of a rail fixator system, the patient underwent the acute shortening and re-lengthening with the Ilizarov technique after resection of the infected zone, right lower limb was 7.9 cm shorter than the left after surgery; (C) Anteroposterior x-ray films at 98 days after the operation, bone healing was observed on both sides of acute shortening and compression. (D) Anteroposterior x-ray films at 176 days after the operation, both lower limbs equal in length without shortening. (E,F). Anteroposterior and lateral x-ray films showed good bony union and good regenerate consolidation at 12 months after the removal of external fixation;(G.H)The patient showed a good function of flexion and extension of the knee joint;.