Segmental Bone Transport with the Monorail Technique in Reconstructing a Bone Defect in the Forearm: A Case Report.

Abstract

Management of posttraumatic segmental bone loss can be challenging. The reconstruction of such defects requires an infection-free zone as well as stable and reliable fixation. The variety of reconstruction methods reflects the complexity in achieving healing in the gap left by bone loss. Distraction osteogenesis, autogenous or allogenic bone-grafting, segmental bone transport, and vascularized and nonvascularized bone transfers are all well-recognized methods of treatment. Most of the associated literature is focused on lower-extremity bone defects; reports of upper-limb bone loss are rare. We used the monorail technique, a combination of an unreamed interlocking intramedullary nail (Wurzburger nail-TREU) and a unilateral external fixator (Wagner apparatus), for transporting a bone segment to reconstruct a 7-cm long posttraumatic bone defect in the radius, which was complicated because of osteomyelitis. The patient achieved full healing and had improved forearm and hand function, but there was some loss of forearm rotation. To the best of our knowledge, use of this technique in reconstructing forearm bone defects has not previously been reported. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-five-year-old man was brought to our trauma center after a motorbike accident. The initial assessment was remarkable only for closed multifragmentary diaphyseal fractures of the left radius and ulna (AO classification 22-C1.2); a displaced olecranon fracture was also evident, as well as early signs and symptoms of compartment syndrome (Fig. 1). Fig. 1 Closed displaced diaphyseal fractures of the left radius and ulna as well as a displaced olecranon fracture are evident. The patient underwent surgery on the same day. The procedure involved fracture fixation with two 3.5-mm locking compression plates (LCPs) and a tension band for the olecranon fracture (Fig. 2). The wound on the volar aspect of the forearm, which was left open after …