Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe?

KINIK H. H., KALEM M.

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, cilt.52, sa.8, ss.2425-2433, 2021 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 52 Sayı: 8
  • Basım Tarihi: 2021
  • Doi Numarası: 10.1016/j.injury.2019.12.025
  • Dergi Adı: INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Abstracts in Social Gerontology, Aerospace Database, CINAHL, Communication Abstracts, EMBASE, MEDLINE, Metadex, SportDiscus, Civil Engineering Abstracts
  • Sayfa Sayıları: ss.2425-2433
  • Anahtar Kelimeler: Tibia, Infected non-union, Large bone defect, Debridement, Ilizarov external fixator, Distraction osteogenesis, External fixation index, External fixation time, DEFECTS, MANAGEMENT, FIXATOR, RECONSTRUCTION, OSTEOMYELITIS
  • Ankara Üniversitesi Adresli: Evet

Özet

Objectives: To evaluate the results of one stage radical debridement and segmental bone transport with circular fixator in the treatment of infected tibial non-union requiring extensive debridement with an average defect size of 8 cm and distraction length of 9,5 cm. Design: Retrospective study. Setting: Level I trauma centre at an academic university hospital. Patients: Thirty patients with infected tibial non-union with an average of 2,9 previous failed operations after a mean 12,5 months post-injury were treated consecutively. The mean age was 39,5 years (R:16- 68). After radical debridement and irrigation, all patients were treated with segmental bone transport using Ilizarov circular fixator. All patients except 3, managed with an open docking protocol without bone grafting. In 2 patients a planned ankle arthrodesis with transport was done. Main outcome measurements: Bone union, resolution of infection, external fixation index (EFI), external fixation time (EFT), bone and functional results for this big defect size. Results: Union and eradication of infection was achieved in all patients. Mean follow-up was 32,5 months (R: 12-72 mo.) The average bone defect after debridement was measured 8.1 cm (R, 6-15). The total distraction length to restore the debridement defect and previous LLD was 9,5 cm (R, 6-15). The mean external fixation time was 13,7 months; the mean external fixation index was 1,49 mo./cm. One non -union, one refracture and one late valgus deformity was managed successfully with plating or nailing and all were healed uneventfully at the completion of the treatment. According to Paley & Maar and Katsenis criteria, the bone results were excellent in 24 and good in 6, functional scores were excellent in 21, good in 7, and fair in 2 patients. Minor complications were 1,36 per patient, major complications were 0,4 per patient and permanent complications were 0,2 per patient in the study group. Conclusion: In the management of large post-infectious bone defects requiring an average 9,5 cm dis-traction; segmental bone transport is safe in terms of union and eradication of infection. The EFI, EFT, complications, bone and functional results do not differ from the other published studies with smaller defect size. (c) 2019 Elsevier Ltd. All rights reserved.