Management of complex femoral nonunion with monorail external fixator: A prospective study.

AIM: To evaluate 30 patients who underwent distraction osteogenesis with monorail external fixator for complex femoral nonunion. METHOD: 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. CONCLUSION: 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.

Cosmetic arm lengthening with monorail fixator.

Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option.

Application of monorail fixator for femoral gap nonunion.

Difficult femoral nonunion takes account of infective nonunion and aseptic gap nonunion. Limb length discrepancy and nonunion need to be tackled simultaneously. Conventionally Ilizarov ring fixator is in vogue but it has some limitations. To overcome these, monorail fixator is an effective alternative. Persistent good results can be obtained if we can get a perfect anatomical alignment and good regeneration.

An unusual cause of radial nerve palsy.

Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate. The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal. On the second postoperative day, following the suction drain removal and dressing, patient developed immediate radial nerve palsy along with wrist drop. We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure.

Proximal Femoral Stress Reaction in A Military Recruit - A Treatment Prospect.

INTRODUCTION: Stress fractures occur in individuals in whom repetitive strenuous muscle and tendon force act on bone; that have not adapted to such forces. Under a constant load, osteoclast resorption and osteoblastic reconstruction of bone are in equilibrium, resulting in normal remodeling. If loading increases, additional bone resorption occurs. Increased osteoclastic activity at sites of stress may cause local weakening and predispose to micro damage. If allowed to progress, such micro fractures may progress to complete fractures. CASE REPORT: A 30-year-old man presented with right thigh pain for 3 days without any history of significant trauma. He was a military recruit with history of running 5 miles a day for last 12 years and was running 20 miles a day for last 5 days before he developed pain. Examination revealed pain to palpation along the proximal medial and lateral right thigh. Range of motion was painful and limited. Radiograph of right hip showed fracture line in intertrochanteric region of femur. CONCLUSION: Here we have reported a case of stress fracture of proximal femur in intertrochanteric region which to our knowledge has not been reported in the literature so far. This fracture is important to recognize early as there are high chances of displacement resulting in increased risk of complications. We suggest immediate anatomical reduction and stable internal fixation to prevent complications and early mobilization to decrease the morbidity.