Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail

Kocaoğlu, Mehmet; Eralp, Levent; Rashid, Haroon; Şen, Cengiz; Bilsel, Kerem

doi:10.2106/jbjs.e.01152

Cited by 96 publications

(63 citation statements)

References 36 publications

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“…Reviewing the literatures, most reports on the treatment of infected nonunions refer to the lower extremity, particularly the tibia [10-13]. Infected nonunion in the upper extremity is a rare event, especially in the forearm [1].…”

Section: Discussionmentioning

confidence: 99%

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Infected forearm nonunion treated by bone transport after debridement

Liu

Lin

et al. 2013

BMC Musculoskelet Disord

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BackgroundThis is a therapeutic study to evaluate the results of the management of forearm infected nonunion using bone transport with external fixators after debridement.MethodsWe have retrospectively reviewed a consecutive series of 21 patients from October 1994 to June 2010 in our institution who were treated for the forearm infected nonunion by bone transport with external fixator after debridement. There were 12 males and 9 females. The mean age of the patients was 27.1 years. Of the initial fractures, nonunion of the radius alone invovled in 7 patients, nonunion of the ulna alone invovled in 12, and nonunion of the radius and ulna invovled in 2. Nineteen limbs (85.7%) were in active infected state with sinus and drainage. The mean amount of bone defect was 3.1 cm (range 1.8-4.6 cm) as measured on plain radiographs.ResultsThe mean follow-up was 77.5 months. All patients achieved bony union and were satisfied with the functional and cosmetic outcome. All the infection had been controlled. The mean external fixation index was 42.5 day/cm. The average time for wound healing was 42 days. The mean length gained was 3.5 cm (2.1-5.3 cm).ConclusionsThe technique of bone transport after debridement is a safe, effective, and minimally invasive treatment for forearm infected nonunion.

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Section: Discussionmentioning

confidence: 99%

“…Cortical bleeding, described as the so-called paprika sign, was accepted as an indication of vital tissue [10]. Wounds were rinsed with pulsed irrigation system and sterilized with iodine complex.…”

Section: Methodsmentioning

confidence: 99%

Infected forearm nonunion treated by bone transport after debridement

Liu

Lin

et al. 2013

BMC Musculoskelet Disord

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“…Gradual correction with a specialized frame is useful for large deformity correction, associated limb lengthening, bone transport to treat segmental defects, 9,12,20,22,23,26,36,37 and stiff hypertrophic nonunion repair. 8,10,12,13,15,16 Gradual correction uses the principle of distraction osteogenesis.…”

Section: Discussionmentioning

confidence: 99%

Repair of Tibial Nonunions and Bone Defects with the Taylor Spatial Frame

Rozbruch

Pugsley

Fragomen

et al. 2008

Journal of Orthopaedic Trauma

146

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“…A locking nail is inserted after debridement and enables rapid bone transport 73. Reduction in axial deviation and external fixation time and improved patient comfort are the advantages.…”

Section: Noninvasive Modalitiesmentioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.

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Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail

Cited by 96 publications

References 36 publications

Infected forearm nonunion treated by bone transport after debridement

Infected forearm nonunion treated by bone transport after debridement

Repair of Tibial Nonunions and Bone Defects with the Taylor Spatial Frame

Infected nonunion of tibia

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