Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame |
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| Affiliation: | 1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain;2. Orthopaedic Surgery Department, Hospital Verge de la Cinta, Tortosa, Spain;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 Biomedical Engineering, Yonsei University, Wonju, Gangwon-Do, 26493, Republic of Korea;2. Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea;1. Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, 1-1-1 Miwa Kurashiki Okayama 710-8602, Japan;2. Department of General Medicine, Kurashiki Central Hospital, Kurashiki, 1-1-1 Miwa Kurashiki Okayama 710-8602, Japan;3. Department of Nephrology, Kurashiki Central Hospital, Kurashiki, 1-1-1 Miwa Kurashiki Okayama 710-8602, Japan;1. Division of Plastic and Hand Surgery, University Hospital Zurich, Switzerland;2. Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland;3. Division of Trauma Surgery, University Hospital Zurich, Switzerland;4. Division of Thoracic Surgery, University Hospital Zurich, Switzerland |
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| Abstract: | IntroductionBone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique.MethodsThe aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques.ResultsA total of 54 patients, with an average bone defect of 8.58 cm (CI95% 7.01–10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases.ConclusionAccording our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than choice of osteotomy technique must play important roles. |
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| Keywords: | Bone transport Osteotomy Distraction osteogenesis Ilizarov technique Regenerated bone |
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