Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects |
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| Institution: | 1. Department of Orthopaedic Surgery, The Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia;2. University of Queensland School of Medicine, Brisbane, QLD, Australia;3. Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia;4. Paley Institute, St. Mary’s Hospital, West Palm Beach, FL, USA;5. Department of Orthopaedic Surgery, Medical School of Istanbul, University of Istanbul, Istanbul, Turkey;6. Wellstar Health System, OrthoAtlanta private practice group, Atlanta, GA, USA;7. Department of Orthopaedic Trauma, St. Vincent’s Hospital, Indianapolis, IN, USA;8. University of Texas Health Science Center, San Antonio, Texas, USA;9. Musculoskeletal Research Unit, Central Queensland University, Rockhampton, QLD, Australia;10. International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA;1. Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany;2. Department of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany;3. \"Fracture Committee\" of the German Knee Society, Germany;1. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran;2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran |
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| Abstract: | IntroductionThis study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length.MethodsIn a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.ResultsThe mean size of the bone defect was 7 cm in Group A, and 5.8 cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P = 0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P = 0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P = 0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P = 0.28).ConclusionsWhile both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.Level of evidence: Level III; Retrospective comparative study |
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| Keywords: | Infected non-union Osteomyelitis Segmental defects Acute shortening Bone transport Bone lengthening Ilizarov method Distraction osteogenesis External fixation Limb salvage |
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