The The Evaluation of the Radiological and Functional Outcome of Distraction Osteogenesis in Patients with Infected Gap Nonunions of Tibia Treated by Bone Transport
DOI:
https://doi.org/10.3889/oamjms.2019.112Keywords:
Distraction Osteogenesis, Ilizarov, LRS, Non UnionAbstract
AIM: The aims of this investigation were: 1) to study the Functional outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System, and 2) to study the Radiological outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System.
METHODS: The study was done with 27 patients of infected gap nonunions of the tibia at Sir JJ Hospitals, Mumbai from 2013-2016. After implant removal, if required radical resection of necrotic tissue and fractures were stabilised with Ilizarov or mono-lateral fixator depending on non-union site. Corticotomy was either done proximally or distally. Patients were followed up at monthly intervals for a minimum of 6 months.
RESULTS: The ASAMI-Bone healing score was Excellent or Good in 86% patients, and Functional score was Excellent or Good in 89% of patients. The commonest problems were of pin tract infection, wire loosening and angulation of the transported segment.
CONCLUSION: Elderly age, persistent infection, sensory loss in the foot, the stiffness of the knee, and above all the patient’s reluctance to go any further given the protracted treatment besides, systemic disorders such as diabetes are all pointers for considering amputation as an alternative.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Aronson J, Rock L, Arkansas. Limb lengthening, Skeletal reconstruction and bone transport with the Ilizarov methods. J Bone Joint Surg Am. 1997; 79:1243-58. https://doi.org/10.2106/00004623-199708000-00019 PMid:9278087
Zile S Kundu, Gupta V. Gap non-union of tibia treated by Huntington's procedure. Indian J Orthop. 2012; 46(6):653-658. https://doi.org/10.4103/0019-5413.104197 PMid:23325967 PMCid:PMC3543882
Dendrinos G.K, S. Kontos. Use of the Ilizarov Technique for Treatment of nonunion of the tibia associated with infection. J Bone Joint Surg. 1995; 77-A:835-46. https://doi.org/10.2106/00004623-199506000-00004
Paley D, Catagni MA, Arganani F et al. Ilizarov treatment of tibia nonunions with bone loss. Clin Orthop Relat Res. 1989; 241:146-65. PMid:2924458
Rosen H. Pseudoarthroses : Infected, Manual of Internal fixation by AO-ASIF Group. 3rd Edition, Chap 19.5.2, 1991:722-23.
Dahl MT, Gulli B, Berg T. Complications of limb lengthening a learning curve. Clin Orthop. 1994; 301:10-18. https://doi.org/10.1097/00003086-199404000-00003
Kulkarni GS. Biomechanics of Ilizarov Ring Fixator, Textbook of Orthopaedics and Trauma, 2nd Edition (177), 2008:1506-1518
Parihar M. Post-operative care in the Ilizarov method. Textbook of Orthopaedics and Trauma, 2nd Edition (196), 2008:1753-1758.
Tang LIU et al. One stage management of post traumatic tibial infected non union using bone transport after debridement. Turk J Med Sci. 2012; 42(6):1111-1120.
Kiran M, Jee R. Bone Transport in Tibial Gap Non-Union—A Series of 25 Cases. Open Journal of Orthopedics. 2012; 2(04):144.
https://doi.org/10.4236/ojo.2012.24027
Vignes GS, Arumugam S, Ramabadran P. Functional outcome of infected non-union tibia fracture treated by Ilizarov fixation. Int J Sci Study. 2014; 2(7):87-92.
Chaddha M, Gulati D, Singh AP, Singh AP, Maini L. Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique. Acta Orthopædica Belgica. 2010; 76(6):811-820. PMid:21302581
Paley FB, Chirstianson D. An analysis of Illizarov and external fixators. Clin Orthop Relat Res. 1989;241:195.
Magadum MP, Yadav CB, Phaneesha MS, Ramesh LJ. Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects. Journal of Orthopaedic Surgery. 2006; 14(3):273-9. https://doi.org/10.1177/230949900601400308 PMid:17200528
Farmanullah Khan MS, Awais SM. Evaluation of management of tibial non union defect with Ilizarov fixator. J Ayub Med Coll Abbottabad. 2007; 19:34-6.
Madhusudhan TR, Ramesh B, Manjunath KS, Shah HM, Sundaresh DC, Krishnappa N. Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions–a prospective study. Journal of trauma management & outcomes. 2008; 2(1):6. https://doi.org/10.1186/1752-2897-2-6 PMid:18651977 PMCid:PMC2515289
Tranquilli PL, Merolli A, Perrone V, Caruso L, Giannotta L. The effectiveness of the circular external fixator in the treatment of post-traumatic of the tibia nonunion. La Chirurgia degli organi di movimento. 2000; 85(3):235-42.
Naique SB, Pearse M, Nanchahal J. Management of severe open tibial fractures: the need for combined orthopaedic and plastic surgical treatment in specialist centres. The Journal of bone and joint surgery. British volume. 2006; 88(3):351-7. https://doi.org/10.1302/0301-620X.88B3.17120 PMid:16498010
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Ayush Kumar Singh, Mangal Parihar, Syed Bokhari
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0