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Combined Technique for the Treatment of Infected Nonunions of the Distal Femur with Bone Loss: Short Supracondylar Nail Augmented Acute Shortening/Lengthening.

OBJECTIVE
Evaluate a combined technique for treating distal femoral bone defects following debridement of osteomyelitis, using an external fixator together with a short supracondylar nail.


DESIGN
Retrospective study.


SETTING
Single tertiary referral centre.


METHODS
Between 2003 and 2018, 23 patients with a mean age of 37.2 years (26 - 56) underwent surgery with the same technique to manage post-debridement defects in the distal femur due to osteomyelitis. This involved acute shortening and intramedullary fixation of the defect site, together with re-lengthening from a proximal osteotomy using simultaneous external fixation. Radiographic union, range of motion of the hip and knee, external fixation time (EFT) and index (EFI), and limb length discrepancy (LLD) were assessed.


RESULTS
The mean follow-up was 51 months (18 - 192). Union was achieved in all patients without recurrence of infection during this follow-up period. The mean knee flexion was 120° and the mean extension deficit was 5° at final follow-up. The mean LLD improved from 5.5 cm (3 to 7) to 0.5 cm (0 to 2). The mean EFI was 29.2 days/cm (20 - 50) and the mean EFT was 115 days (90-150). Radiographic scores were excellent in 15 cases, good in 6, and fair in 2. Functional scores were excellent in 14 cases, good in 7, and fair in 2.


CONCLUSION
This combined strategy was an effective method for treating distal femoral segmental bone defects after debridement of osteomyelitis, with a high rate of union and acceptable complication rates.


LEVEL OF EVIDENCE
Level IV.