Infected lower tibial nonunions without bone grafting - Reliable union using the Ilizarov technique

Chaudhary, Milind; Jain, Sandhya; Pragadeeswaran, Vigneshwaran; Lakhani, P H

doi:10.4103/2455-3719.168745

Cited by 3 publications

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“…Among the involved studies, 6 were retrospective case series, 10,12-18 and 2 were case reports. 13,19 The systematic review included a total of 43 patients with massive tibial defects treated by fibular transport using the Ilizarov methods.…”

Section: Resultsmentioning

confidence: 99%

“…17 Two studies described residual limb length discrepancy of less than 2.5cm deemed as a non-complication using the ASAMI criteria. 16,19 One study reported the development of squamous cell carcinoma on the salvaged limb which eventually required amputation. The neoplastic occurrence was detected after the removal of the fixator and was attributed to the previous chronic wound status of the patient.…”

Section: Discussionmentioning

confidence: 99%

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Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Dumlao¹,

Balce²

2021

Acta Med Philipp

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Introduction and Objectives. Segmental tibial bone loss from tumor, trauma, or infection is a debilitating, limb-threatening scenario where treatment principles involve aggressive resection of infected tissues usually leading to large defects requiring reconstruction. A systematic review was conducted to determine the best available evidence related to the ipsilateral medial fibular transport using the Ilizarov frame in the management of these massive tibial bone defects. Methods. Multiple medical online database search for articles containing the keywords: ipsilateral medial fibular transport, medial fibula transport, medialization of the fibula using the Ilizarov fixator, ring external fixator, vascularized free fibula, vascularized fibula transfer, and other related MeSH terms was done. Data was summarized to describethe mean age, bone defect, external fixator time, external fixator index, and bone and functional results using the ASAMI criteria. Results. Eight studies with a total of 43 patients with massive tibial bone defects treated by fibular transport using the Ilizarov methods were identified. The mean age was 25.27 years (6.5-44.4) with a mean bone defect of 13.57 cm (9.52-17). The mean length of follow-up was 37.67 months (18-70.2). The bone union rate was 100%. Mean external fixation time was 9.59 months (8.31-10.88) and external fixation index was 0.61 months/cm (0.52-0.70). The majority of patients have an excellent bone (84%) and functional (52%) results. The average rate of complication was determined at 0.74/patient (95% CI, 0.60-0.89). The most common complications include pin-tract infection (37%), residual loss of motion/stiffness of knee and ankle (35%), and pain on the transport site (21%). Conclusion. Ipsilateral medial fibular transport using the Ilizarov frame provides a viable alternative treatment option for the treatment of massive tibial bone defects.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Dumlao¹,

Balce²

2021

Acta Med Philipp

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“…Although there is controversy regarding the effect of ankle arthrodesis on adjacent-joint arthritic changes, adverse effects of ankle fusion have been reported, including decreased walking speed and stride length. [27][28][29][30] Thomas et al 31 reported that ankle arthrodesis resulted in an alteration of hindfoot function and gait with significantly reduced AOFAS scores and increased Ankle Osteoarthritis Scale (AOS) scores for disability.…”

Section: Discussionmentioning

confidence: 99%

“…We achieved infection control in all cases. Chaudhary et al 28 had a retrospective study on 37 infected distal tibial nonunion and had a union rate of 84% and infection eradication in 100% of cases. Their study included all infected nonunion of an area extending up to 10 cm from the ankle joint, whereas this study was limited only to the periarticular area in the lower tibial end.…”

Section: Discussionmentioning

confidence: 99%

Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Zayda,

Badr

2023

Techniques in Foot &Amp; Ankle Surgery

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Nonunion of the periarticular distal tibial fractures is a challenging issue with limited options for treatment. The study aims to evaluate the outcomes of treatment of non-united periarticular distal tibial fractures using Ilizarov external fixation. A retrospective study included 16 patients with distal tibial fracture nonunion treated with Ilizarov fixator from 2014 to 2019 with a minimum 1-year follow-up after frame removal. Fibular plating was done in 8 cases and supplementary interfragmentary screws at the nonunion site in 5 cases. Primary or delayed bone graft was used in 11 patients. The ASAMI protocol was used to assess the bone and functional results. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to assess the functional outcomes. Study included 9 males and 7 females, mean age of 47.4±14.1 years. 15 cases had previous surgeries for nonunion. 7 had active infection. duration of nonunion was 24.1±13.2 months. Mean duration of fixation was 5.7±1.0 months. Mean follow-up was 21.8±8.5 months. Mean AOFAS score improved from 52.4±3.7 preoperatively to 85.4±9.8 at the latest follow-up (P<0.001). Finally, the infection was resolved, and union was achieved in all patients. Bone results were excellent in 3 cases and good in 13, whereas functional results were excellent in 6 cases, good in 8, fair in 1, and poor in 1. Ilizarov fixator is a reliable option for treating nonunion in the periarticular distal tibial fractures. It provides secure fixation for short distal fragments, especially with history of infection, those with bad skin conditions, previous failed internal fixation, and osteopenic bone. Level of Evidence: Level IV.

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Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.

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Infected lower tibial nonunions without bone grafting - Reliable union using the Ilizarov technique

Cited by 3 publications

References 1 publication

Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Infected nonunion of tibia

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