Ilizarov treatment for pseudarthrosis of the tibia due to haematogenous osteomyelitis

Abstract

Haematogenous osteomyelitis is associated with poverty and overcrowding. The infection may extend through the entire length of a long bone and as a part of debridement, the sequestrum may be removed, resulting in a defect. Infection of tibial growth plates would result in altered growth rates of the tibia and fibula and produce deformities and shortening. Fourteen children were treated for pseudarthrosis of the tibia because of haematogenous osteomyelitis. Their ages ranged from 4 to 13 years. There were nine male and five female children. The treatment included the use of Ilizarov techniques in the form of distraction of a stiff pseudarthrosis (n=5) and acute shortening and relengthening for bone defects (n=9). No active infection was present at the time of treatment. In all cases, the bone defects were bridged and consolidated. No residual infection was present. Transient palsy of the common peroneal nerve occurred in two cases during deformity correction and lengthening. Refracture occurred in one case at the site of a previous wire. Residual leg shortening of more than 1 inch was present in two cases. The results were satisfactory in 12 cases (86%) and unsatisfactory in two cases (14%) because of residual shortening and ankle joint fusion. Ilizarov techniques comprehensively address the problems associated with chronic haematogenous osteomyelitis of the tibia in children despite the difficulties in their application because of the nature of the illness.

Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

“…Osteomyelitis is a relatively common condition in Africa because it is related to poverty and its consequences, including malnutrition and overcrowding. 4 Management of osteomyelitis, seen most often at the stage of chronicity and associated with local endemics (tuberculosis, AIDS, and sickle cell disease), is difficult. 5 This case report presented nonunion of the tibia plus a lower limb length discrepancy due to an early epiphysiodesis, which was itself due to an alteration of the distal growth plate of the same tibia after iterative surgery.…”

“…The use of external fixation alone or combined with intramedullary nailing is favored by several authors. 4,7,8 The most common complications are paralysis of the common peroneal nerve, refracture, and residual shortening. 4 The combined methods also tend to result in a higher rate of reinfection.…”

“…4,7,8 The most common complications are paralysis of the common peroneal nerve, refracture, and residual shortening. 4 The combined methods also tend to result in a higher rate of reinfection. 4 In addition to treating pseudarthrosis, the Ilizarov external fixator offers the advantage of allowing the correction of abnormalities associated with this disease (angular deformities, limb length inequality).…”

“…4 The combined methods also tend to result in a higher rate of reinfection. 4 In addition to treating pseudarthrosis, the Ilizarov external fixator offers the advantage of allowing the correction of abnormalities associated with this disease (angular deformities, limb length inequality). The additional immobilization by synthetic cast in this case permitted a solid regenerate bone, which was estimated to be 76.8% of the diameter of the contralateral tibia, and a healing index of 49 days/cm, comparable to those reported by Kucukkaya et al 9 (52.3 days/cm) and Eralp et al 8 (40.09 days/cm).…”

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

“…The long bone metaphysis is the most vulnerable part. If the infection has not been effectively controlled or treated, the whole bone will become involved and may lead to bone defects [2]. Concomitant pyogenic arthritis in infants occurs in the hip, knee, and other large joints, mostly as the result of OM extended to the adjacent joints.…”