Callus distraction for humeral nonunion with bone loss and limb shortening caused by chronic osteomyelitis

Abstract

Nonunion of the humerus with bone loss and shortening due to osteomyelitis is rare but difficult to treat. We describe our experience with a callus distraction technique using a monolateral external fixator for the treatment of this condition. Between October 1994 and January 2004, 11 patients were treated. There were seven males and four females, with a mean age of 14 years (10 to 17). The mean bone loss was 1.9 cm (1 to 2.7) and the mean length discrepancy in the upper limb was 5.6 cm (3.5 to 8.0). The mean follow-up was for 106 months (54 to 166). The mean external fixation index was 34.8 days/cm (29.8 to 40.5). The mean lengthening was 9.5 cm (5.5 to 13.4). There were seven excellent results, three good and one poor. There were nine excellent functional results and two good. The treatment of humeral nonunion with bone loss and shortening due to osteomyelitis by callus distraction is a safe and effective means of improving function and cosmesis.

Management of bone defect of humerus by Ilizarov method

“…Intraoperatively, I didn't expose the docking site of two of the cases for removal of the false joints as the failed implants were removed before their presentation to me, the limbs were protected by braces, similar to the study done by t. liu et al [7]. While in the remaining 8 cases, refreshing of nonunion sites done till capillary cortical bleeding seen from the fragments, Paprika sign, which is considered as the endpoint of resection [8].…”

Regeneration of the proximal tibial epiphysis during callus distraction for atrophic nonunion after infantile osteomyelitis

“…In this study, atrophic nonunion and proximal tibial defect caused by osteomyelitis in a patient resulted in leg-length discrepancy and deformity. Typically, we did not expose the docking site to remove sclerotic bone ends during the callus distraction, and the atrophic nonunion was Wnally healed, indicating that osteogenesis could occur again in the sites of atrophic nonunion [11,12]. We considered that the realignment of aVected bone tissues and reconstruction of normal structures might stimulate the resting mesenchymal stem cells restoring the potential of angiogenesis and thus contributed to the healing of atrophic nonunion.…”

Cost of external fixationvsexternal fixation then nailing in bone infection

“…Ilizarov technique is one of the most effective techniques used in bone infection: for stabilization, limb reconstruction, and fracture healing [3] . Ilizarov technique and external fixation system has many advantages including versatility, and high success rate in treatment of bone deformity, and infection [4] . But the long duration of external fixation is associated with many complications including: pin tract infection, joint stiffness, disuse atrophy, psychological stress, long duration of absence from work, and many other complications [5] .…”