Treatment of infected nonunion of the juxta-articular region of the distal tibia

Eralp, İbrahim Levent; Kocaoğlu, Mehmet; Dikmen, Göksel; Azam, Mohsin; Balcı, Halil İbrahim; Bilen, F. Erkal

doi:10.3944/aott.2015.15.0147

Cited by 23 publications

(60 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…Distal tibial non unions are difficult to treat, and the small distal fragment presents a major challenge for the surgeon [9]. Several authors have reported on the outcomes of treating distal tibial non-unions [9,14,15,31,32]. Earlier studies have used ankle arthrodesis as a salvage procedure [14,15], while more recent studies have attempted to preserve the integrity of the ankle joint [9,31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have reported on the outcomes of treating distal tibial non-unions [9,14,15,31,32]. Earlier studies have used ankle arthrodesis as a salvage procedure [14,15], while more recent studies have attempted to preserve the integrity of the ankle joint [9,31,32]. Marsh et al treated seven patients with distraction osteogenesis and ankle arthrodesis, and achieved union in six cases at an average of 7.9 months; one patient required a below knee amputation [15].…”

Section: Discussionmentioning

confidence: 99%

“…Periarticular distal tibial non-union can be even more difficult to treat [9]. Small distal bone fragments, disuse osteopenia, soft tissue atrophy, infection, and adjacent joint contractures create genuine challenges.…”

Section: Introductionmentioning

confidence: 99%

“…Small distal bone fragments, disuse osteopenia, soft tissue atrophy, infection, and adjacent joint contractures create genuine challenges. Various treatment options exist including primary arthrodesis or joint preservation [9]. Fixation techniques include blade-plates, conventional plates, external fixation, or circular external fixation with or without bone transport, shortening, distraction osteogenesis, or a combination of these techniques.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Molepo

Barnard²,

Birkholtz

et al. 2018

Eur J Orthop Surg Traumatol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Molepo

Barnard²,

Birkholtz

et al. 2018

Eur J Orthop Surg Traumatol

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show abstract

Pseudoarthrosis

Çakmak¹,

Cıvan²

2018

Basic Techniques for Extremity Reconstruction

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Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

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IntroductionStandardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients.MethodsA comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated.ResultsThe search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies.ConclusionsThis extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.

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Treatment of infected nonunion of the juxta-articular region of the distal tibia

Abstract: External fixator and/or combined treatment are effective and reliable methods to treat infected nonunion of the distal tibia. Every patient should be evaluated according to their infection level and bony defects for reconstruction.

Cited by 23 publications

References 22 publications

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Pseudoarthrosis

Insights into treatment and outcome of fracture-related infection: a systematic literature review

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