THE MONORAIL SYSTEM - SEGMENTAL BONE TRAN SPORT AFTER UNREAMED INTERLOCKING NAILING

A treatment protocol is demonstrated, consisting of an osteotomy, eith er proximal or distal, of the bone defect with subsequent segmental tr ansport via an anteromedially (tibia) or laterally (femur) mounted AO external fixation over an unreamed interlocking nail (monorail system) . Twenty patients were treated by this method with indications as foll ows: 13 had a segmental bone defect of the tibia, 3 of the femur. Thre e patients showed post-traumatic and postinfectious leg-length discrep ancies and one was treated for hypertrophic non-union of the femur. De fect distance varied between 5 and 18.5 cm and average time for transp ort was 19,42 days/cm for the tibial shaft, 15,93 days/cm for the femu r. Two patients developed deep infection, which required change of tre atment, removing the monorail system and application of an Ilizarov ap paratus. Despite complications using the monorail system, all patients healed and no amputations were required. The monorail system can be u sed as an alternative to the Ilizarov method under certain criteria of patient selection; these criteria are shown by an algorithm for segme ntal bone defects without infection, respecting the soft-tissue status with or without neurovascular compromise.