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DOS Kongressen 2017 ·
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Plating assisted bone transport in the femur using a
motorized lengthening nail - a new technique
Ulrik Kähler Olesen, Tobias Nygaard
Reconstructive orthopedic surgery, trauma section, Rigshospitalet
Background:
Open femoral fractures with bone loss are difficult to treat.
Purpose / Aim of Study:
A new technique to treat femoral bone loss, using a
plate and a motorized lengthening nail is presented.
Materials and Methods:
Three patients with extra articular femoral bone de-
fects from open fractures were operated in 2016. The patients were evalu-
ated for LLD, MAD, time to weight bearing, defect size, complications. Follow
up was minimum 30 weeks. Surgical technique: After debridement and external
fixation, a plate spanning the defect is inserted, maintaining length and rota-
tion. Meticulous surgical planning was done using long standing radiographs
and radiographs of contralateral femur with a calibration device to estimate
correct length. After 6 weeks, negative biopsies and negative infection count
(WBC,CRP) were found. The nail was then inserted in a retrograde or antegrade
fashion and a transport segment created with a drill bit osteotomy. Some short-
ening was necessary to allow soft tissue closure in two cases. In one case the
nail was pre- distracted to allow retrograde transport (pulling the segment)
Findings / Results:
Average defect size was 75 mm. All patients were fully
weight bearing at 25 weeks. LLD was zero,15 and 45 mm respectively. MAD
was within normal limits in all cases. All patients displayed some degree of het-
erotopic ossification and reduced knee motion. All patients needed grafting and
a docking procedure
Conclusions:
The presented technique is simple and efficient, eliminating the
side effects of external fixation. It may reduce treatment time compared to al-
ternative methods. Femoral fractures with bone loss are prone to cause quad-
riceps fibrosis and heterotopic ossification, that may require further surgery, ir-
respective of which bone substitution method is used. Strict infection control
and meticulous surgical planning is required.
No conflicts of interest reported
173.