Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame

Corona, Pablo S.; Ramírez-Núñez, L.; Amat, Carles; Carrera, Luis Gómez

doi:10.1016/j.injury.2017.07.024

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Some authors, on the other hand, suggest systematically approaching the bone ends (open docking site) with bone grafting as an additional procedure [ 33 ]. Based on the results of this study and other previous investigations [ 16 ], currently the docking site is systematically approached for debridement and an iliac crest graft in all cases of bone transport > 4 cm.…”

Section: Discussionmentioning

confidence: 99%

“…Repeat debridement is performed and specimens obtained to confirm infection eradication. DO [ 16 ] based procedures are our technique of choice for reconstruction of massive segmental tibial defects in adults. For small defects (< 1 cm) we simply shorten the leg through monofocal compression, with or without autologous cancellous bone graft.…”

Section: Three-stage Surgical Treatment Protocol (Tsp)mentioning

confidence: 99%

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Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Corona

Carbonell-Rosell

Vicente

et al. 2021

Arch Orthop Trauma Surg

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Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Three-stage Surgical Treatment Protocol (Tsp)mentioning

confidence: 99%

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Corona

Carbonell-Rosell

Vicente

et al. 2021

Arch Orthop Trauma Surg

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“…Of this technique, all possible pathologies can be resolved simultaneously, including infection, defects, length, alignment, and soft tissue problems. Via published articles [12][13][14][15][16], the advantages of external rail fixators are lightweight, simple intraoperative installation, convenient postoperative care, and acceptable patient compliance. However, the structure of the unilateral framework is not stable enough, which requires exquisite preoperative design and postoperative care to prevent potential complications, such as pin tract infection, axial deviation, soft tissue contracture, joint stiffness, etc.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Peng

Tian³

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to evaluate the outcomes of bifocal bone transport in the treatment of femoral bone defects caused by infections. Methods Clinical and radiographic data of patients with infected femoral nonunion treated by the bifocal bone transport at our hospital were analyzed retrospectively, from January 2008 to December 2019. Depending on the location of bone defects, the patients were divided into three groups (proximal, intermediate, and distal). The Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria was applied to assess the bone and functional outcomes. Postoperative complications of three groups were documented and compared. Results Seventy-six cases of infected femoral bone defects (31 cases of proximal, 19 cases of intermediate, and 26 cases of distal) were managed by bifocal bone transport successfully with a mean follow-up time of 30.8 months (range, 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 to 60 years). The bone union was received in 76 cases with a mean of 6.9 months (range, 5 to 8 months). Pin tract infection was observed in twenty-nine cases (38.1%), 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 using an external rail fixator was a practical method to treat the femoral bone defects, since the satisfactory rate of bone union and limb function recovery. Complications of distal femoral bone transport were more severe than the proximal and intermedia, but the rate of complication was the least of the three groups. Soft-tissue-related complications were more likely to occur in the intermediate bone transport.

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Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol

Cánovas

Ros

Navarro

et al. 2021

Eur J Orthop Surg Traumatol

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Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame

Cited by 5 publications

References 21 publications

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol

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