28-year-old male with posttraumatic infected (vancomycin resistant enterococcus fecaelis) femur with 9 cm bone loss. (a) Preoperative AP X-ray showing bone loss and intramedullary rod in place. (b) After stage 1 surgery to remove hardware, apply monolateral external fixator, and insert antibiotic coated cement beads. Gradual shortening of the defect was done. (c) After stage 2 surgery which involved distal femur osteotomy for lengthening and further shortening of the defect. Note the removal of antibiotic beads. (d) At end of distraction. Note 9 cm distal femur lengthening and compression at the proximal docking site. (e)–(h) Follow-up one year after frame removal.
