Treatment of Massive Tibial Bone Loss Due to Chronic Draining Osteomyelitis: Fibula Transport Using the Ilizarov Frame

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

doi:10.3928/01477447-20070801-19

Cited by 17 publications

(9 citation statements)

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“…The Ilizarov external fixator device has been widely used to correct limb-length 1B discrepancies, lengthen limb and amputation stumps, and treat myriad bony deformities, defects, and nonunions. 1,2,6 To the current authors' knowledge, no published cases exist in the North American literature demonstrating its use in the setting of an infected tibial nonunion after amputation where it simultaneously salvages stump length and fuses a nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…T he Ilizarov apparatus has been widely used since the 1940s for limb lengthening, filling in bony defects, and treating nonunions [1][2][3][4][5] and osteomyelitis. 6,7 The concept of compressiondistraction osteogenesis central to the use of the Ilizarov system is often used to preserve, lengthen, and correct limb deformity but can also be applied to the treatment of infected tibial nonunions following a below-knee amputation. To the authors' knowledge, such an application of the Ilizarov external fixation device for chronically infected nonunion after amputation has yet to be reported.…”

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confidence: 99%

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Ilizarov External Fixator for Stump Salvage in Infected Nonunions

Onyekwelu¹,

Hasan²,

Chapman³

2013

Orthopedics

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Infected nonunions are potentially difficult complications to treat in the context of complex tibial fractures. Often, such complications necessitate amputation to prevent further sequelae, such as fulminant sepsis and complete loss of the limb. As such, the eradication of infection, the decision regarding when to amputate, and the length of the residual stump are important factors to optimize patient outcome. The authors present a unique scenario whereby an Ilizarov external fixation device was used to treat an infected tibial nonunion while simultaneously salvaging stump length to enable fitting for a below-knee prostheses. The use of the Ilizarov device can prevent abrupt dissemination of infection, stabilize the fracture, and bridge nonunion gaps. This is augmented by the unique ability of the construct to be periodically readjusted and realigned where needed to permit osteogenesis and proper alignment. The result in this case was complete eradication of infection, with the use of continuous antibiotics as a pharmacological adjunct, union of the tibial fragments, and a below-knee amputation with adequate stump length and prosthetic fit. The success of this treatment strategy was predicated on the above factors, with an emphasis on amputation level and its effect on function. The Ilizarov external fixator is a device that has been widely used to treat limb-length discrepancies, correct deformities, and induce osseous growth in bony nonunion. The authors present the Ilizarov device as a viable option for the treatment of infected tibial nonunions and stump length salvage.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ilizarov External Fixator for Stump Salvage in Infected Nonunions

Onyekwelu¹,

Hasan²,

Chapman³

2013

Orthopedics

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“…12,13 However, these methods cannot be used when there is no suitable proximal or distal tibial remnant for transport. Catagni et al, 6 Catagni, Ottaviani and Camagni 14 and Atkins et al 5 have described the use of the Ilizarov technique to transport the fibula medially in 12 adults with massive defects of the tibia after trauma and chronic osteomyelitis. The advantages of this technique are that it is simple, requires minimal dissection of the fibula, and gradual transport ensures maintenance of the blood supply.…”

Section: Discussionmentioning

confidence: 99%

Medial transport of the fibula using the Ilizarov device for reconstruction of a massive defect of the tibia in two children

Shiha

Khalifa

Assaghir

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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We present two children with massive defects of the tibia and an associated active infection who were treated by medial transport of the fibula using the Ilizarov device. The first child had chronic discharging osteomyelitis which affected the whole tibial shaft. The second had sustained bilateral grade-IIIB open tibial fractures in a motor-car accident. The first child was followed up for three years and the second for two years. Both achieved solid union between the proximal and distal stumps of the tibia and the fibula, with hypertrophy of the fibula. The first child had a normal range of movement at the knee, ankle and foot but there was shortening of 1.5 cm. The second had persistent anterior angulation at the proximal tibiofibular junction and the ankle was stiff in equinus.

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“…Various techniques have been used to treat large segmental tibial defects such as autogenous cortical bone grafts [1], tibiofibular synostosis, ipsilateral fibular graft [2–8], allograft reconstruction [9], vascularized free fibula transfer [10–12], and bone transport. Ipsilateral fibular transport [13–15] is a novel option in limb salvage surgery for patients with large tibial defects.…”

Section: Introductionmentioning

confidence: 99%

“…A large graft of ipsilateral fibula raised on a pedicle of peroneal tibial muscles, anterior tibial muscles, and the peroneal vessels, which are aligned and fixed with the tibia in its posterior long axis, could provide a sound mechanical and biological basis of union. However, open methods require large surgical dissections and skeletal stability could be difficult to accomplish [3, 4, 7, 13–15].…”

Section: Introductionmentioning

confidence: 99%