A 10 cm Traumatic Femoral Defect Treated with a Transport Technique Followed by a Lengthening Procedure. Sequential Use of a Monotube External Fixator and an Intramedullary Rod

This case report details the management of a 10 cm femoral defect. A 56 year old female sustained bilateral open femur fractures after her parachute malfunctioned. Initial treatment included an emergent debridement and irrigation and temporary external fixation. A subtrochanteric femoral osteotomy was performed on postinjury day 6. Femoral transport proceeded for 2 months, during which time the traumatic femoral defect healed spontaneously. The retrograde femoral nail was locked, and the monotube was subsequently removed. The patient started independent ambulation and began noting her leg to be short 2–3 cm. Despite accommodative shoe inserts, she developed low back and hip and knee pain. She elected for a femoral lengthening procedure, which entailed lengthening over a new nail and a new external fixator. This required 4 months and ended with removal of the second external fixator and locking the second femoral rod. This patient is now 3 years since injury and reports minimal back and leg pain and nearly equal leg lengths.