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War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Patients and methods

This single centre retrospective study reviews the outcomes of 30 war-injured patients with established infected tibial nonunion after sustaining grade IIIB open fractures. Patients were treated by radical bony and soft-tissue resection and bone transport using the Ilizarov bifocal technique, without the use of systemic antibiotics or bone grafting.

Results

The series comprised 29 males and 1 female with a mean age of 30.4 years and a mean nonunion of 8.6 months at index operation. Patients had previously undergone a mean of 1.3 operations (range 1–3), and the mean size of tibial defect was 6.9 cm (range 4–11 cm) post radical debridement. Bony union was achieved at the tibial docking sites after a mean of 4.5 months in 29 patients (97%) and frames were worn for a mean of 9.7 months (range 7.2–15 months), giving a mean fixation index of 1.48 months/cm. One patient failed to unite at their tibial docking site. Soft-tissue transport successfully closed the soft-tissue defects in all but four patients, who required split-skin grafting. According to the Paley scoring system 19 patients had excellent bony results, 10 good and 1 poor; the functional results were excellent in 13 patients, good in 14, fair in 2 and poor in 1; and there were 1.4 complications per patient. Over a mean follow-up of 99 months no patient refractured their reconstruction, developed any symptoms or signs of recurrent infection, or required amputation.

Conclusion

The Ilizarov technique with bone transport continues to be the most versatile, adaptive and effective method of treatment in these complex cases, and can very successfully deal with the associated large soft-tissue and bony defects without the use of routine bone-grafting, systemic antibiotics or soft-tissue flaps.

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References

  1. McHale KA, Ross AE (2004) Treatment of infected tibial non unions with debridement, antibiotic beads, and the Ilizarov method. Mil Med 169(9):728–734

    PubMed  Google Scholar 

  2. Dendrinos GK, Kontos S, Lyritsis E (1995) Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am 77(6):835–846

    PubMed  CAS  Google Scholar 

  3. Richmond J, Colleran K, Borens O, Kloen P, Helfet DL (2004) Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma 18(9):603–610

    Article  PubMed  Google Scholar 

  4. Chin KR, Nagarkatti DG, Miranda MA, Santoro VM, Baumgaertner MR, Jupiter JB (2003) Salvage of distal tibia metaphyseal nonunions with the 90 degree cannulated blade plate. Clin Orthop Relat Res 409:241–249

    Article  PubMed  Google Scholar 

  5. Lowenberg D, Feibel R, Louie K, Eshima I (1996) Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects. Clin Orthop Relat Res 332:37–51

    Article  PubMed  Google Scholar 

  6. Malizos KN, Zalavras CG, Soucacos PN, Beris AE, Urbaniak JR (2004) Free vascularized fibular grafts for reconstruction of skeletal defects. J Am Acad Orthop Surg 12(5):360–369

    PubMed  Google Scholar 

  7. Paley D, Maar DC (2000) Ilizarov bone transport treatment of tibial defects. J Orthop Trauma 14(2):76–85

    Article  PubMed  CAS  Google Scholar 

  8. Rozbruch SR, Pugsley JS, Fragomen AT, Ilizarov S (2008) Repair of tibial nonunions and bone defects with the Taylor Spatial Frame. J Orthop Trauma 22(2):88–95

    Article  PubMed  Google Scholar 

  9. Cattaneo R, Catagni M, Johnson EE (1992) The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 280:143–152

    PubMed  Google Scholar 

  10. Paley D, Catagni M, Argnani F, Villa A, Benedetti GB, Cattaneo R (1989) Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 241:146–165

    PubMed  Google Scholar 

  11. Hosny G, Shawky MS (1998) The treatment of infected non-union of the tibia by compression-distraction techniques using the Ilizarov external fixator. Int Orthop 22(5):298–302

    Article  PubMed  CAS  Google Scholar 

  12. Atesalp AS, Basbozkurt M, Erler E, Sehirlioglu A, Tunay S, Solakoglu C, Gur E (1998) Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds. Int Orthop 22(6):343–347

    Article  PubMed  CAS  Google Scholar 

  13. Marsh DR, Shah S, Elliot J, Kurdy N (1997) The Ilizarov method in nonunion, malunion and infection of fractures. J Bone Joint Surg Br 79(2):273–279

    Article  PubMed  CAS  Google Scholar 

  14. Lerner A, Fodor L, Soudry M, Peled IJ, Herer D, Ullmann Y (2004) Acute shortening: modular treatment modality for severe combined bone and soft-tissue loss of the extremities. J Trauma 57(3):603–608

    Article  PubMed  Google Scholar 

  15. Rozbruch SR, Weitzman AM, Watson JT, Freudigman P, Katz HV, Ilizarov S (2006) Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma 20(3):197–205

    Google Scholar 

  16. Aronson J (1997) Limb-lengthening, skeletal reconstruction and bone transport with the Ilizarov method. J Bone Joint Surg Am 79(8):1243–1258

    PubMed  CAS  Google Scholar 

  17. Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81–104

    PubMed  Google Scholar 

  18. Catagni MA, Camagni M, Combi A, Ottaviani G (2006) Medial fibula transport with the Ilizarov frame to treat massive tibial bone loss. Clin Orthop Relat Res 448:208–216

    Article  PubMed  Google Scholar 

  19. El-Gammal TA, Shiha AE, El-Deen MA, El-Sayed A, Kotb MM, Addosooki AI, Ragheb YF, Saleh WR (2008) Management of traumatic tibial defects using free vascularised fibula or Ilizarov bone transport: a comparative study. Microsurgery 28(5):339–346

    Article  PubMed  Google Scholar 

  20. Song HR, Kale A, Park HB, Koo KH, Chae DJ, Oh CW, Chung DW (2003) Comparison of internal bone transport and vascularised fibular grafting for femoral bone defects. J Orthop Trauma 17(3):203–211

    Article  PubMed  Google Scholar 

  21. Tahmasebi MN, Mazlouman SJ (2004) Ilizarov method in treatment of tibial and femoral infected non-unions in patients with high-energy trauma and battle-field wounds. Acta Med Iran 42(5):343–349

    Google Scholar 

  22. Magadum MP, Basavaraj Yadav CM, Phaneesha MS, Ramesh LJ (2006) Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects. J Orthop Surg 14(3):273–279

    CAS  Google Scholar 

  23. Saleh M, Rees A (1995) Bifocal surgery for deformity and bone loss after lower limb fractures. Comparison of bone-transport and compression-distraction methods. J Bone Joint Surg Br 77(3):429–434

    PubMed  CAS  Google Scholar 

  24. Kocaoglu M, Eralp L, Rashid HU, Sen C, Bilsel K (2006) Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am 88(10):2137–2145

    Article  PubMed  Google Scholar 

  25. Sen C, Kocaoglu M, Eralp L, Gulsen M, Cinar M (2004) Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases. J Orthop Trauma 18(3):150–157

    Article  PubMed  Google Scholar 

  26. Kristiansen LP, Steen H (2002) Reduced lengthening index by use of bifocal osteotomy in the tibia: comparison of monofocal and bifocal procedures with the Ilizarov external fixator. Acta Orthop Scand 73(1):93–97

    Article  PubMed  Google Scholar 

  27. Menon DK, Dougall TW, Pool RD, Simonis RB (2002) Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma 16(7):491–497

    Article  PubMed  Google Scholar 

  28. Lerner A, Fodor L, Stein H, Soudry M, Peled IJ, Ullmann Y (2005) Extreme bone lengthening using distraction osteogenesis after trauma: a case report. J Orthop Trauma 1(6):420–424

    Google Scholar 

  29. Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA (2005) Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury 36(5):662–668

    Article  PubMed  CAS  Google Scholar 

  30. Meffert RH, Inoue N, Tis JE, Brug E, Chao EY (2000) Distraction osteogenesis after acute limb-shortening for segmental tibial defects. Comparison of a monofocal and a bifocal technique in rabbits. J Bone Joint Surg Am 82(6):799–808

    PubMed  CAS  Google Scholar 

  31. Al Sayyad MJ (2006) Taylor Spatial Frame in the treatment of pediatric and adolescent tibial shaft fractures. J Pediatr Orthop 26(2):164–170

    PubMed  Google Scholar 

  32. Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB (2006) Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop 26(6):794–798

    PubMed  Google Scholar 

  33. Rogers MJ, McFadyen I, Livingstone JA, Monsell F, Jackson M, Atkins RM (2007) Computer hexapod assisted orthopaedic surgery (CHAOS) in the correction of long bone fracture and deformity. J Orthop Trauma 21(5):337–342

    Article  PubMed  Google Scholar 

  34. Kristiansen LP, Steen H, Reikeras O (2006) No difference in tibial lengthening index by use of Taylor spatial frame or Ilizarov external fixator. Acta Orthop 77(5):772–777

    Article  PubMed  Google Scholar 

  35. Maini L, Chadha M, Vishwanath J, Kapoor S, Mehtani A, Dhaon BK (2000) The Ilizarov method in infected nonunions of fractures. Injury 31(7):509–517

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest statement

No competing interest or funding declared.

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Authors and Affiliations

  1. Institute for Orthopaedic Surgery and Traumatology, Clinical Centre for Serbia, Višegradska 26, 11000, Belgrade, Serbia

    Marko Bumbaširević, Aleksandar Lešić & Ivan Milošević

  2. Special Hospital for Orthopaedic Surgery “Banjica”, Mihajla Avramovica 28, 11000, Belgrade, Serbia

    Slavko Tomić

  3. Department of Trauma and Orthopaedics, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK

    Henry Dushan E. Atkinson

  4. 9 Sutcliffe Close, London, NW11 6NT, UK

    Henry Dushan E. Atkinson

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  1. Marko Bumbaširević
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  2. Slavko Tomić
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  5. Henry Dushan E. Atkinson
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Correspondence to Henry Dushan E. Atkinson.

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Bumbaširević, M., Tomić, S., Lešić, A. et al. War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method. Arch Orthop Trauma Surg 130, 739–749 (2010). https://doi.org/10.1007/s00402-009-1014-6

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  • DOI: https://doi.org/10.1007/s00402-009-1014-6

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