Acute shortening versus bone transport for the treatment of infected femur non-unions with bone defects

Şen, Cengiz; Demіrel, Mehmet; Sağlam, Yavuz; Balcı, Halil İbrahim; Eralp, Levent; Kocaoğlu, Mehmet

doi:10.1016/j.injury.2019.08.021

Cited by 18 publications

(25 citation statements)

References 17 publications

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“…A range of techniques exists for the management of bone loss in the femur, each with their own risk profile. For smaller defects, acute shortening then lengthening is likely a more predictable option 3 , 18 , 19 ; however, this needs to be weighed up with the limits of soft-tissue shortening. 20 , 21 Bone transport may be more suitable for larger defects but equally comes with a greater potential for complications.…”

Section: Discussionmentioning

confidence: 99%

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

Wright

Bates

Heidari

et al. 2011

Strategies in Trauma and Limb Reconstruction

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Background Variety of techniques for management of segmental femoral bone loss have been described, each with different advantages and challenges during treatment. The development of motorized lengthening nails has provided a potential for all internal bone transport, avoiding some of the difficulties with external fixation in the femur. At present, there is limited published literature on experiences in this technique. Aim The development of this technique aimed to overcome the difficulties previously reported for internal bone transport in the femur, particularly varus deformity and joint stiffness. Technique We describe the technique of double plating with bone transport utilizing a magnetic lengthening nail to manage segmental femoral bone loss. The benefits of the technique are discussed, along with specific challenges and lessons that have been learned through experience of internal bone transport. Conclusion Use of a magnetic lengthening nail and double plating as a method of all internal bone transport provides an option for the management of massive femoral bone loss, while avoiding some of the challenges that have been reported with the existing techniques. Clinical significance This technique provides an additional method in the armamentarium of the trauma or limb reconstruction surgeon treating massive femoral bone loss. How to cite this article Wright J, Bates P, Heidari N, et al. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019;14(2):94–101.

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Section: Discussionmentioning

confidence: 99%

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

Wright

Bates

Heidari

et al. 2011

Strategies in Trauma and Limb Reconstruction

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“…Since the potential limitations of the external xation itself, many surgical methods have been applied to decrease the EFI to avoid complications, then receive better clinical results further [24][25][26][27][28][29][30]. Gupta et al [31] reported a consecutive series of 14 tibial nonunions, which were managed successfully by unilateral external rail xator combined with locking plates for simultaneous xation, with a mean defect size of 6.4 cm, mean external xator index of 21.2 days/cm, and a per-patient complication incidence of 0.5.…”

Section: Discussionmentioning

confidence: 99%

“…Via published articles [6,9,20,22,[45][46][47][48], the application of bone transport in the treatment of infected femoral bone defects is more satisfactory than in the tibia, especially in the grade of bone healing. However, the external xation time, the external xation index of our cohort was higher than the staged bone transport technique, which combined with internal xation or acute shortening and re-lengthening [4,9]. For instance, Sen et al [9] showed a mean EFI of 31.8days/cm in a cohort of 17 patients treated by the modi ed technique of acute shortening and re-lengthening.…”

Section: Discussionmentioning

confidence: 99%

“…Nonunion of infection has still been a tricky problem for orthopedic surgeons, occurring commonly after open reduction and internal xation procedures for closed fractures, or external xation for open fractures [1][2][3][4][5][6][7][8][9]. Such bone infection is associated with soft tissue loss generally since the long-term course and complex treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The reconstruction of bone defects in the environment of infection remains a great challenge for clinicians, since the complex microbiota and drug resistance, as well as poor vascularity of scar tissue [13][14][15][16]. Some reconstruction procedures have been utilized to reconstruct femoral bone defects, including bone grafting, bone transport (distraction osteogenesis) using external xators, vascularized bone grafting, Masquelet technique [9,17,18]. However, there are also limitations and complications in these treatments, such as morbidity at the donor site, stress fractures, and restriction of the size of bone defects.…”

Section: Introductionmentioning

confidence: 99%

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Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

Peng

Liu

Tian

et al. 2021

Preprint

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Background: The purpose of this study is to evaluate the outcomes of single-level bone transport in the treatment of femoral bone defects after radical debridement, which were caused by infections.Methods: Clinical and radiographic data of patients with infected femoral nonunion treated with a unilateral external fixator (Orthofix limb reconstruction system, LRS) at our hospital from 2010 to 2019 were analyzed retrospectively. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes and postoperative complications evaluated by Paley classification. Results: Seventy-six cases of infected femoral bone defects (31 proximal, 19 intermediate, and 26 distal) were managed by single-level bone transport using a unilateral external fixator with a mean follow-up time of 30.8 (23 to 41) months. There were 58 men (76.3%) and 18 women (23.6%), with a mean age of 38.8 years (range, 23 – 60 years). The bone union was achieved in 76 cases with a mean time of 6.9 months (range, 5-8 months). Complications included 29 cases (38.1%) of pin tract infection, 7 cases (9.2%) of muscle contractures, 3 cases (7.9%) of joint stiffness, 13 cases (17.1%) of axial deviation, 2 cases (2.6%) of delayed union, one case (1.3%) of nonunion, and none (0%) of transport gap re-fracture. One patient (1.3%) was scheduled for knee arthroplasty when bone transport treatment ended.Conclusions: Bone transport in the reconstruction of femoral bone defects using unilateral external rail fixator had a satisfactory rate of bone healing and limb function recovery. Complications of distal femoral bone transport were more severe than other sites, but the complication rate was the least of the three. Complications of the proximal were comparable to the intermediate, and soft-tissue-related complications were more likely to occur in the intermediate transport.

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Augmentation with a non-vascularized autologous fibular graft for the management of Cierny-Mader type IV chronic femoral osteomyelitis: a salvage procedure

Bas,

Balci,

Kocaoglu

et al. 2023

International Orthopaedics (SICOT)

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Acute shortening versus bone transport for the treatment of infected femur non-unions with bone defects

Cited by 18 publications

References 17 publications

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

Augmentation with a non-vascularized autologous fibular graft for the management of Cierny-Mader type IV chronic femoral osteomyelitis: a salvage procedure

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