The Clinical Analysis Of Bone Transport Treating Large Femoral Bone Defect And Limb Discrepancy By Using Inlaided External Fixator With Or Without Intramedullary Nail

Objective:To provide a evidance-based of reasonable treatment for large femoral defect and limb discrepancy by comparing the clinical outcome of bone transport using inlaid external fixator with or without intramedullary fixation.Materials:We carried a retrospective study collecting data of surgical treatment of large bone defects and limb discrepancy from June1994to January2008. According to the treatment methods, bone transport with inlaid external fixator was divided into Group A, combined with intramedullary fixation was divided into the Group B. Group A included26patients(16males and10females) and mean age was32.2±5.1years; Group B included30patients(18males and12females) and mean age was33.2±4.7years old. AS AMI score, external fixation index, consolidation index, external fixation time and postoperative complications were evaluated.Results:All patients in two groups were followed up. Group A were follow-up of average81.4±6.4months, and77.7±8.9months in Group B. All patients achieved bone healing, of which in group A14cases mean external fixation time was24.8±6.9months, mean bone healing index was40.6±2.7days/cm, the average external fixation index was32.1±2.9days/cm. In group B28patients were follow-up with mean external fixation time was8.7±1.9months, the average time of intramedullary fixed13.4±4.6months, average bone healing index was37.8±2.4days/cm and the average external fixation index was31.4±2.3days/cm. In group A, patients were observed with pin screw loosing in6cases who need to be reset;22cases of pin tract infection signs of disease appeared (via oral or intravenous antibiotics to cure);2patients re-fracture dealed with the manual reduction and plaster external fixation of fracture healing.12cases of patients with left knee limited (less than the contralateral40°). In group B, there is no loose thread the needle and re-fracture cases. However,2patients had severe persistent deep infection. All patients were satisfactory degree of knee recovery. Between the two groups in the needle tract infections, pin loosing, re-fracture and nonunion in lengtnening areawere have statistically significant. In ASAMI scores of bone healing,17patients achieved excellent,7good, poor in2cases in group A, excellent in28cases, good in1case and poor in lin group B; in terms of functional recovery,14cases of excellent,12good in group A;26patients excellent,4cases of good in B group. Two groups of bone healing and functional recovery of both data were statistically significant (P<0.05).Conclusion:Compared to methods without intramedullary fixation, bone transport treating large femoral defects and limb discrepancy by inlaid external fixator with intramedullary fixation has better evaluation on issues such as fracture healing, functional recovery, time of removal the external fixation. However, attentions should be paid to the possible infection spread through the intramedullary fixation.