ArticleInternational journal of surgery case reports2026
Acute shortening and re-lengthening (ASRL) procedure combined with RhBMP-2 to treat femur non-union with leg length discrepancy: a case report.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Femoral shaft non-union complicated by leg length discrepancy (LLD) and segmental bone loss remains a significant reconstructive challenge. Conventional bone transport techniques may involve long external fixation times, multiple surgeries, and soft-tissue morbidity. The acute shortening and re-lengthening (ASRL) method offers an alternative by achieving immediate bone contact and tissue closure, followed by gradual restoration of length. The adjunctive use of recombinant human bone morphogenetic protein-2 (rhBMP-2) may enhance osteogenesis at the docking and regenerate sites. Case presentation: We present a 24-year-old male patient with a femoral non-union and a 6 cm leg length discrepancy following multiple failed surgeries and hardware removal. The operative strategy comprised thorough debridement of the non-union site, acute shortening of the femur for direct end-to-end contact, application of rhBMP-2 at the docking interface, and placement of a monorail external fixator. A proximal femoral corticotomy was then performed for gradual distraction at 1 mm/day after a 10-day latency. Full-length restoration, radiographic union, and pain-free weight-bearing were achieved at 12 months. No major complications occurred. Clinical discussion: The ASRL technique, combined with rhBMP-2 on docking site, may represent a viable biomechanical-biological strategy for complex femoral non-union with LLD. Conclusions: The combined mechanical-biological strategy of ASRL with
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