Session VIII - Reconstruction

*Correction of Posttraumatic Leg-Length Discrepancy and Segmental Bony Defects with Use of the "Monorail" Technique: Patient Outcomes and Complications

Hari Vasan, BScN¹; Cameron Cooke, MD²; Stewart Hutton, BScN²; Emil H. Schemitsch, MD¹; Lisa M. Wild, BScN¹; Peter J. O'Brien, MD²; Michael D. McKee, MD¹,

¹St. Michaels Hospital, University of Toronto, Toronto;

²Vancouver General Hospital, University of British Columbia, Vancouver, Canada (a-University of Toronto Scholarship Fund)

Purpose: We sought to determine patient-oriented outcomes and complication rates after bone transport with use of an external fixator placed over an intramedullary nail (the "monorail" technique).

Methods: We identified 44 patients (44 limbs) who had undergone bone transport with use of the monorail technique. There were 31 men and 11 women with a mean age of 37 years (range, 17 to 50). Preoperative diagnoses included posttraumatic length discrepancy or segmental bone defect. All patients had a unilateral fixator placed over an implanted intramedullary nail. Once length correction or bone transport was achieved, the fixator was removed and the nail was "locked". The mean amount of lengthening/bone regeneration was 5.3 cm (range, 2 to 18 cm). The mean lengthening index was 24.5 days/cm (duration of external fixation per centimeter of bone length gained), with a range from 10 to 50 days/cm. There were 15 complications (34%): six premature consolidations, three infected pin sites, two hardware failures, two cases of localized osteomyelitis, one deep vein thrombosis, and one nonunion. There were no refractures, angular deformities, or cases of intramedullary sepsis. There were no further premature consolidations once the standard 7- to 10-day "latent phase" (after osteotomy and before lengthening) was eliminated in the latter half of the study.

Discussion: Bone transport with use of the monorail technique is associated with a dramatically improved lengthening index and a lower major complication rate than traditional ring fixator methods. Patient satisfaction with the procedure was high due to earlier frame removal and absence of secondary deformity.

Conclusions: Our study confirms the significant advantages of use of the monorail technique for bone transport/limb lengthening. The time in the fixator was dramatically reduced, and complications associated with earlier techniques, such as angular deformity or refracture after frame removal, were not seen. This technique is our treatment of choice for posttraumatic limb lengthening/bone transport.

* If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options and e-consultant or employee.