We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistent pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications.

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CONTEXT AND OBJECTIVE: Superficial infection at wire and pin insertions in the skin is a frequent disorder among patients utilizing the Ilizarov method. The objective of this study was to evaluate the effectiveness of daily topical application of 10% polyvinylpyrrolidone-iodine solution against infections of the holes for Kirschner wires and Schanz pins among patients using Ilizarov external fixators, in comparison with cleaning these holes only with 0.9% sterile physiological saline solution. DESIGN AND SETTING: Controlled randomized clinical trial, in the Orthopedics and Traumatology Outpatient Clinic, Hospital São Paulo, and Orthopedics and Traumatology Center of Jundiaí. METHODS: 30 patients were treated using the Ilizarov technique: 15 were instructed to apply 0.9% physiological saline dressing on the wire and pin insertions and 15 to apply 0.9% physiological saline plus 10% polyvinylpyrrolidone-iodine. Patients were evaluated at outpatient return visits for identification of signs and symptoms of superficial infection at wire and pin insertion sites. Samples were collected from cases of purulent exudate secretion, for culturing and clinical tests. RESULTS: The chi-squared and Fischer exact tests were applied, but no statistically significant association between the intervention of topical polyvinylpyrrolidone-iodine solution and the prevention of infections at wire and pin insertions could be found. CONCLUSIONS: Topical 10% polyvinylpyrrolidone-iodine solution applied daily to Kirschner wire and Schanz pin insertions did not reduce the incidence of superficial infection at these holes, in comparison with mechanical removal of dirt using 0.9% physiological saline solution.

Foram tratados 28 pacientes num total de 29 pés, com idade média de 25,8, predomínio do sexo masculino 16 pacientes (57,2%), cor branca 25 pacientes (89,2%), lado direito 16 pacientes (57,2%). Quanto à etiologia houve um predomínio das seqüelas de fraturas de calcâneo 11 pacientes (37,9%) e poliomielite 11 pacientes (37,9%), as outras causas foram necrose do talus 2 pacientes (6,9%), barra óssea 2 pacientes (6,9%), artrose primária 2 pacientes (6,9%) e paralisia cerabral 1 paciente (3,5%). O tempo médio de consolidação foi de 3,5 meses. Foram utilizados enxerto ósseo em 11 pacientes (44%). Houve necessidade em 2 casos (6,9%) de se promover o alongamento do calcâneo para se aumentar o pitch do mesmo. A montagem é simples e se baseia em 2 anéis com fixação transóssea através de 2 fios olivados no talus e 2 no calcâneo. Como resultado foi obtido 100% de consolidação, ausência de dor e osteoporose e boa sensibilidade do pé. Das complicações encontradas além das costumeiras ou próprias do método 1 (3,5%) paciente apresentou infecção profunda em 1 dos fios. O método mostrou-se eficiente independente da etiologia com 100% de consolidação além de permitirem uma certa independência ao paciente durante o tratamento.