Segmental Resection and Bone Transport Distraction Osteogenesis in the Management of Chronic Osteomyelitis

Abstract

A clinical retrospective study of surgical treatment of chronic posttraumatic osteomyelitis by the Ilizarov method was conducted by analysing the end results. The included cases were patients with chronic osteomyelitis who underwent surgery. The average length of bone defect was 9.5 cm (4-28 cm). In all cases corticotomy and application of the Ilizarov device was necessary to initiate bone transport. Thirteen patients (62 %) presented delayed union at the docking site. In 4 patients compression-distraction was necessary to promote union. In 9 patients (43 %) the Ilizarov device was removed and interlocked intramedullary nailing was performed after eradication of the infection was confirmed by clinical and laboratory data. Recurrence of infection occurred in one patient. Elimination of infection and solid bone formation was the end result for all patients. Two refractures at the docking site needed reapplication of an Ilizarov device. In one case angular deformity of more than 10 degrees needed correctional osteotomy.

Key words

Chronic Osteomyelitis - Ilizarov method - complications secondary intramedullary nailing

References

• 1 Baumgart R, Betz A, Kettler M, Zeiler C, Schweiberer L. Perspektiven der Kallusdistraktion.  Unfallchirurg. 1996;  99 84-91
• 2 Dean Cole J. The vascular response of bone to internal fixation. In: The science and practice of intramedullary nailing. Browner BD (ed). Second Edition Williams and Wilkins 1996; 43-69
• 3 Delloye C, Delefortrie G, Coutelier L, Vincent A. Bone regenerate formation in cortical bone during distraction lengthening.  Clin Orthop. 1990;  250 34-42
• 4 Hessmann M H, Rommens P M. Wann sind Verfahrenswechsel nach Segmenttransport möglich bzw. indiziert?.  Osteosynthese International. 1999;  7 (Suppl 1) 46-51
• 5 Ilizarov G A. The principles of the Ilizarov method.  Bull Hosp Joint Dis. 1988;  48 1-11
• 6 Ilizarov G A. Clinical application of tension-stress effect for limb lengthening.  Clin Orthop. 1992;  250 8-26
• 7 Karabasi A, Lambiris E, Tyllianakis M, Sourgiadaki E. Eine Vergleichstierexperimentelle Untersuchung zwischen Kortikotomie und Osteotomie bei Verlängerungen der langen Röhrenknochen mit der Methode von Ilizarov. Hefte zu Der Unfallchirurg. 61. Jahrestagung der D.G.U. 1997; 726-730
• 8 Kojimoto H, Yasni N, Goto T, Matsudo S, Shimomura Y. Bone lengthening in rabbits by callus distraction: The role of periosteum and endosteum.  J Bone Joint Surg [Br]. 1988;  70 543-549
• 9 Kristiansen L P, Steen H. Lengthening of the tibia over an intramedullary nail, using the Ilizarov external fixation. Major complications and slow consolidation in 9 lengthenings.  Acta Orhop Scand. 1999;  70 271-274
• 10 Lee W H, Huang S C. Femoral Lengthening: callotasis with Ilizarov external fixator alone and with intramedullary locking nail.  J Formos Med Assoc. 1997;  96 98-102
• 11 Lin C C, Huang S C, Liu T K, Chapman M W. Limb lengthening over an intramedullary nail. An animal study and clinical report.  Clin Orthop. 1996;  330 208-216
• 12 Paley D, Herzenberg J E, Paremain G, Bhave A. Femoral lengthening over an intramedullary nail. A matched-case comparison with llizarov femoral lengthening.  J Bone Joint Surg [Am]. 1997;  79 1464-1480
• 13 Raschke M J, Mann J W, Oedekoven G, Clandi B F. Segmental transport after unreamed I.N. Preliminary report of a “Monorail” system.  Clin Orthop. 1992;  282 233-240
• 14 Rhinelander F W. Circulation in Bone. In: Bourne GH (ed). The Biochemistry and Physiology of Bone. Vol. 2. Academic Press, New York 1972; 1-77
• 15 Rueter A, Brutscher R. Die Ilizarov-Kortikotomie und Segmentverschiebung zur Behandlung großer Tibiadefekte.  Operat Orthop Traumatol. 1989;  1 80-89
• 16 Schmidt H GK, Kranz H W, Siebert C. Die Behandlung von langstreckigen Infekt-Defekt-Pseudarthrosen mit Segmenttransport im Ringfixateur.  Osteosynthese International. 1997;  5 212-220
• 17 Stahl J P, Reinhold Z, Hartmann B, Schnettler R. Perspektiven der Kallusdistraktion in der Behandlung der offenen Frakturen und der posttraumatischen chronischen Osteitis.  Osteosynthese International. 1997;  5 185-192
• 18 Vandoros N, Karabasi A, Tyllianakis M, Lambiris E. Behandlungsprinzipien infizierter Pseudarthrosen nach der Methode von Ilizarov. Wann ist Verfahrenswechsel notwendig?. Hefte zu Der Unfallchirurg. 62. Jahrestagung der D.G.U. 1998; 306-307
• 19 Windhager R, Tsuboyama T, Siegl H, Groszschmidt K, Seidl G, Shneider B, Plenk H. Effect of bone cylinder length on distraction osteogenesis in the rabbit tibia.  Journal of Orthopaedic Research 13. 620-628