Acute shortening versus bone transport for the treatment of infected femur non-unions with bone defects |
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| Affiliation: | 1. Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih 34050 Istanbul, Turkey;2. Biruni University Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey;1. WakeMed Health & Hospitals, Raleigh, NC, United States;2. University of North Carolina, Chapel Hill, NC, United States;3. East Carolina University Brody School of Medicine, Greenville, NC, United States;4. Harvard T.H. Chan School of Public Health, Cambridge, MA, United States;5. Orange Park Medical Center, Orange Park, FL, United States;1. Department of Orthopedic Surgery, KK Women’s and Children’s Hospital, Singapore;2. National University of Singapore, Singapore;1. Department of Orthopaedic Surgery, University of Virginia, USA;2. University of Virginia School of Medicine, USA;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine, University of Bergen, Bergen, Norway;1. Department of Traumatology Hospital České Budějovice, Czech republic;2. Department of Traumatology Hospital Liberec, Czech republic;1. Department of Orthopaedic Surgery, Hiroshima-Nishi Medical Center, Japan;2. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan |
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| Abstract: | BackgroundThe bone transport technique has been a well-known method in the treatment of osteomyelitis of the long bones with large segmental bone defects. However, one of the major drawbacks with this traditional technique is the long-lasting consolidation period, which may entail infectious and non-infectious complications. To overcome this drawback, several techniques were developed, one of which is acute shortening and re-lengthening. The aims of this study were: 1) to present our experience with a new modified technique of acute shortening and re-lengthening using a monolateral external fixator combined with a retrograde intramedullary nail, and 2) to compare its results with the classic Ilizarov bone transport method in the management of infected non-unions of the distal femur with bone loss.MethodsThis retrospective study compared these two techniques. 17 patients were treated using our modified technique of acute shortening and re-lengthening (Group A); 15 patients were treated using segmental bone transport (Group B). The average follow-up was 66 months (range: 24–180) in Group A and 70 months (range: 24–240) in Group B. The mean bone loss was 5.5 cm (range: 3–10) in Group A and 5.9 cm (range: 3–10) in Group B. The primary outcome of the present study was to compare the external fixator time (EFT) and external fixation index (EFI) between the two groups. The bone and functional status were also assessed.ResultsThe mean EFI was lower in Group A (mean: 31.8 days/cm; range: 24–50) than in Group B (mean 48.7 days/cm; range: 40–100) (p = 0.02). The mean EFT was shorter in Group A (mean: 120 days; range: 100–150) than in Group B (mean: 290 days; range: 100–400) (p = 0.0003). With respect to the bone and functional results, no difference was observed.ConclusionsAlthough both techniques could be employed safely in the treatment of infected non-union of the distal femur with size defects ranging between 3 cm and 10 cm, our modified technique of acute shortening and re-lengthening may confer greater patient satisfaction because of shorter EFI. |
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| Keywords: | Acute shortening Bone transport Infected non-unions of the femur Bone defect |
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