Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

Abstract

The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20–55 years). All patients previously undergone an average of 2.9 operations (range: 1–6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3–12 cm), and all patients were suffering from soft tissue defects (range: 5–17 cm2). The mean external fixator time (EFT) was 48 weeks (range: 30–62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33–62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0–3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

Bone transport versus acute shortening for the management of infected tibial bone defects: A meta-analysis

“…At present, most of the research claims to perform bone grafting at the docking site to reduce the bone union time. [25] According to previous literature reports, the bone grafting rate of the BT group ranged from 14.3% to 40% [1,23,45] compared to 20-43% in the AST group, which is consistent with the present study. [2,11,36]…”

“…In terms of reports, limb length discrepancy, permanent nerve and vascular damage, vascular crisis, re-fracture and newly formed bone infection are rare, and thorough debridement is the key step to controlling bone infection. [4] Studies reported that complications in the BT group ranged from 8.3% to 100% [1,4,23,42] and 9% to 100% in the AST group [32,33,36,37,43]. Sarah et al recommended the use of Doppler ultrasonography to assess distal pulses as necessary and to choose the appropriate shortening method according to the soft-tissue and wound condition.…”

“…[2,8,9,[17][18][19][20][21][22] However, bone transfer is the preferred technique for the treatment of infected tibial bone defects. [1,4,23,24] Ilizarov reconstruction techniques include two main clinical treatment protocols: bone transport (BT) and acute shortening and gradual lengthening (ASD). [11,25] Bone transport is a safe and reliable approach of tackling segmental tibia bone defect.…”

“…The present meta-analysis showed that AST was superior to BT from the aspect of the EFI, which is an effective index to evaluate the treatment of bone defect and non-union with the Ilizarov technique, which is closely related to age, pathological characteristics, osteotomy position, elongation speed and bone defect length. [40,41] Many studies reported that the EFI of the bone transport group ranged from 0.87 to 2.8 months/cm [4,5,23,42] compared to 1.2-2.5 months/cm in the acute shortening group. [24,30,32,33,35,36,39,43] In the present study, significant difference was detected in the two groups in terms of the EFI (P <0.05) ( Fig.…”

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

“…Currently, Ilizarov reconstructions, the Masquelet technique, vascularised and non-vascularised bone grafts and bone substitutes are the main methods to treat tibia defects [2,8,9,[17][18][19][20][21][22]. However, bone transfer is the preferred technique for the treatment of infected tibial bone defects [1,4,23,24]. Ilizarov reconstruction techniques include two main clinical treatment protocols: bone transport and acute shortening and gradual lengthening [11,25].…”