Medial Fibula Transport with the Ilizarov Frame to Treat Massive Tibial Bone Loss

Catagni, Maurizio A.; Camagni, Marco; Combi, Alessandro; Ottaviani, Giulia

doi:10.1097/01.blo.0000205878.43211.44

Cited by 38 publications

(36 citation statements)

References 21 publications

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“…The reported time for hypertrophy of the fibula varies from one to two years or from two to four years; however, Tuli et al stated that no significant change in the diameter of the fibula is observed after five years (6,17). Fracture of tibialized fibula was not reported in most studies of fibular centralization with different techniques (3,5,6,(9)(10)(11). Keeting et al reported one stress fracture of the fibula in 16 cases of fibular transfer that were treated with sufficient immobilization time.…”

Section: Discussionmentioning

confidence: 95%

“…At 5-year follow up two of the seven patients walked wearing orthoses for protection of the leg from trauma. All of patients were adults (10). However, in another study of fibular transfer in two children because of fracture and infection with defects of 11 and 12 cm, the time for transfer and retaining Ilizarov device was 2.5 to 4 months with protection and an additional one to two months thereafter.…”

Section: Results Of Various Techniquesmentioning

confidence: 99%

“…Bone graft was used at four docking sites in two patients because of nonunion after fibular transfer or to augment union and bone formation. The patients had weight bearing throughout treatment; the frame was removed after consolidation and then a cast was applied (10).…”

Section: Medial Transport Of the Fibula Using Various Techniquesmentioning

confidence: 99%

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Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature

Rahimnia¹,

Fitoussi²,

Penneçot³

et al. 2012

Trauma Mon

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This study elaborates on the issue of segmental bone loss of the tibia and its treatment.Segmental defects of the tibia are challenging therapeutic problems for both the physician and the patient. These defects may be caused by severe trauma, infection, tumors and congenital processes. Several different techniques have been described for treatment of these defects including the Papineau technique, allograft reconstruction, bone transport using the Ilizarov frame, free vascularized fibular graft, tibiofibular synostosis and medial transport of the fibula with Tuli's technique, use of the Ilizarov frame and Huntington's procedure. All of these techniques have their specific advantages as well as disadvantages. Some of these techniques are used rarely i.e. the Papineau technique. The procedure of choice for most large tibial defects is bone transport with Ilizarov's technique; but in some cases the tibial remnant is inadequate for lengthening and we must use alternative treatments. In the three aforementioned techniques, the fibula is transferred with peroneal and anterior tibial muscles on a pedicle of peroneal vessels. This transfer retains a biological component of vital bone that allows for a shorter time for consolidation, increased remodeling potential and resistance to infection. It also has better long-term mechanical properties. Hypertrophy of the centralized fibula is described as attaining twice its original diameter or twice the size of the contralateral tibia. Hypertrophy has been seen in nearly all cases of the fibular centralization. Maximum hypertrophy is seen in children and besides patient age, is related to bony union and weight bearing. The reported time for hypertrophy of fibula varies from one to four years. No significant change in the diameter of the fibula was observed after five years. Fracture of tibialized fibula was not reported in many studies of fibular centralization with different techniques. In the reviewed articles, there were no cases of valgus deformity of the ankle. Either the patients were satisfied with the final results despite appearance of the lower extremity and the presence of some angular deformities, although in most cases, the deformities were mild. In this review we conclude that tibialisation of the fibula in selected cases is a reasonable alternative for the treatment of massive tibial defects.

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Section: Discussionmentioning

confidence: 95%

Section: Results Of Various Techniquesmentioning

confidence: 99%

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Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature

Rahimnia¹,

Fitoussi²,

Penneçot³

et al. 2012

Trauma Mon

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“…[1][2][3][4] Su tratamiento es complejo y controvertido, y entre las técnicas de reconstrucción se cuentan el transporte óseo, 2,5 los autoinjertos óseos libres o vascularizados, 3,6 las megaprótesis, 7,8 la técnica descrita por Masquelet con la "membrana inducida" 9,10 y los aloinjertos óseos molidos [11][12][13] o estructurales. 4,[14][15][16][17] La elección del tratamiento dependerá del sitio y el tamaño del defecto, el estado del miembro y sus partes blandas, la edad del paciente, la disponibilidad de injertos óseos de banco y, por supuesto, de la experiencia del cirujano.…”

Section: Discussionunclassified

“…9,10 Hay vasta experiencia en el uso de aloinjertos para el tratamiento de defectos segmentarios diafisarios en las resecciones tumorales, 16,19,20,24,27 no así en los defectos de origen traumático. [1][2][3][4]24 El uso de aloinjertos, sobre todo estructurales, se ha incrementado especialmente en las últimas décadas, hecho que se relaciona con el aumento de la cantidad y calidad de los bancos de huesos y tejidos, 24,29-32 los cuales procesan, conservan y atienden la bioseguridad de estos últimos, haciendo que los injertos sean cada vez de más fácil acceso para el cirujano ortopédico.…”

Section: Discussionunclassified

Aloinjerto óseo intercalar en defecto postraumático segmentario de fémur

Vedoya¹,

Garabano²,

Lago³

et al. 2012

Rev. Asoc. Arg. Ort. y Traumatol

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Un varón de 34 años sufrió, en un accidente de tránsi-to con vuelco, una fractura expuesta del tercio distal del fémur derecho (Gustilo III B) y lesión grave de las partes blandas con pérdida de cobertura cutánea y masa muscular del muslo derecho. Fue atendido inicialmente en otro centro, donde se le realizaron múltiples limpiezas quirúr-gicas por una infección recurrente, con cultivos positivos para Acinetobacter baumanii, y recibió minociclina más ciprofloxacina hasta la negativización de los cultivos (se desconocen las dosis). Finalmente se estabilizó el miembro con un tutor externo monoplanar por la cara externa del muslo y se realizó la cobertura del defecto con injertos de piel.El paciente, derivado a nuestro centro a los 6 meses de evolución, presentaba al ingresar dolor en el foco, una cicatriz fibrosa adherida de 15 cm de largo, con déficit de masa muscular y tejido celular subcutáneo, que involucraba de manera circunferencial el 70% del diámetro del muslo derecho, pérdida de capital óseo supracondíleo del fémur derecho de unos 8 cm y un acortamiento del miembro de 15 cm ( Fig. 1A-C).Se retiró el tutor externo y se realizó una limpieza quirúrgica, en la cual se encontró material necrótico en el foco. El segmento de 10 cm distales del fémur proximal presentaba mal aspecto, por lo que se decidió su resección durante el tratamiento definitivo (Fig. 1D). Con cultivos positivos para Enterococcus faecalis sensible a la ampicilina se comenzó el tratamiento antibiótico intravenoso (amoxicilina 1 g cada 8 horas y trimetoprima-sulfametoxazol (TMS) Forte, 1 comprimido cada 8 horas) hasta el alta hospitalaria. Debió completar el tratamiento antibiótico (amoxicilina 1 g cada 24 horas y TMS Forte 1 comprimido cada 24 horas durante un año).A los 45 días se realizó el tratamiento definitivo del defecto óseo con un aloinjerto estructural intercalar con hueso de nuestro banco de tejidos (congelado, no irradiado), de 15 cm de longitud, asociado a injerto molido en los sitios de contacto injerto-huésped, y un clavo endomedular retrógrado acerrojado ( Fig. 2A-D). El paciente realizó marcha con dos muletas con carga del 10% durante el primer mes posoperatorio, con una flexión-extensión de rodilla de 0º a 5º. La carga se fue aumentando progresivamente hasta llegar al 80% al sexto mes, cuando radiográficamente se observaron claros signos de consolidación e integración en las uniones injerto-huésped. Comenzó con ejercicios de flexión y extensión activa al tercer mes de la operación.Con una movilidad de 0°a 20º, eritrosedimentación de 5 mm (VN de 0 a 16) y PCR de 0,2 mg/dl (VN de 0 a 0,3), el paciente dejó la asistencia para caminar a los 10 meses. Puede verse en los controles radiográficos hasta los 3 años la progresiva incorporación y remodelación del injerto (Figs. 2 y 3). Actualmente tiene una movilidad activa de 0°a 75º y realiza una marcha ilimitada e indolora, sin asistencia. Caso clínico 2Un varón de 26 años sufrió un accidente automovilísti-co (choque frontal a 200 km/h) y presentó una fractura expuesta mediodiafisaria ...

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Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents

Ottaviani

Robert

Huh

et al. 2013

Cancer

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BACKGROUND:To the best of the authors' knowledge, there has been relatively little research published to date regarding very longterm survivors of childhood and adolescent osteosarcoma. In the current study, the authors compared the very long-term survival outcomes of patients with osteosarcoma who were treated with either limb salvage procedures or amputation. METHODS: A total of 38 patients with osteosarcoma who survived 20 years from the time of diagnosis were divided into 2 groups according to whether they underwent amputation or limb salvage. Participants were asked to complete a questionnaire concerning their education, employment, annual income, marital status, health insurance, lifestyle, siblings, and all current and past health issues. RESULTS: Education, employment, marital status, and health insurance were not found to differ significantly between the 2 groups of survivors, who described themselves as being similar to their siblings. Eight percent of survivors underwent secondary amputation because of complications with an endoprosthesis. The cumulative incidence of second primary neoplasms was 13%, and this finding was significantly higher in females and in survivors who underwent radiotherapy and had a genetic predisposition. The second primary malignancies were breast cancer (ductal invasive carcinoma, ductal in situ carcinoma, and leiomyosarcoma), mediastinal leiomyosarcoma, and squamocellular carcinoma of the oral cavity and the uterine cervix. Amputees required more assistive walking support than survivors who received limb salvage treatment (P <.05, chi-square test). CONCLUSIONS: Despite the many challenges that osteosarcoma survivors face, patients who survived 20 years after their initial diagnosis reported having overall adjusted well to their physical limitations and were productive individuals.

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Medial Fibula Transport with the Ilizarov Frame to Treat Massive Tibial Bone Loss

Abstract: Therapeutic Study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 38 publications

References 21 publications

Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature

Treatment of Segmental Loss of the Tibia by Tibialisation of the Fibula: A Review of the Literature

Aloinjerto óseo intercalar en defecto postraumático segmentario de fémur

Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents

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