Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail

Eralp, Levent; Kocaoglu, Mehmet; Rashid, Haroon
August 2007
Journal of Bone & Joint Surgery, American Volume;2007 Supplement 2, Part 2, Vol. 89-A, p183
Academic Journal
BACKGROUND: Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical débridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an intramedullary nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days/cm, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.


Related Articles

  • RECONSTRUCTION OF SEGMENTAL BONE DEFECTS DUE TO CHRONIC OSTEOMYELITIS WITH USE OF AN EXTERNAL FIXATOR AND AN INTRAMEDULLARY NAIL. Kocaoglu, Mehmet; Eralp, Levent; Rashid, Haroon Ur; Sen, Cengiz; Bilsel, Kerem // Journal of Bone & Joint Surgery, American Volume;Oct2006, Vol. 88-A Issue 10, p2137 

    Background: Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction...

  • Osteomyelitis of the Femur Complicating Streptococcus milleri Endocarditis. Archibald, Lennox K.; Harrelson, John M.; Reller, L. Barth // Orthopedics;Jul2005, Vol. 28 Issue 7, p707 

    Presents a case study of a patient who developed acute osteomyelitis of the femur as a complication of Streptococcus milleri-group endocarditis. Medical history of the patient; Signs and symptoms manifested; Treatment administered to the patient.

  • Reconstruction of Large Diaphyseal Defects of the Femur and the Tibia with Autologous Bone. Dumont, Charles E.; Exner, Ulrich G. // European Journal of Trauma & Emergency Surgery;Feb2009, Vol. 35 Issue 1, p17 

    Post-traumatic segmental bone defects of the femur and the tibia above the critical size require special attention because conventional bone grafts result in high rates of nonunion. The biological and biomechanical aspects of this challenging surgery, as well as ongoing refinements to achieve...

  • Opening Wedge High Tibial Osteotomy Using a Novel Technique. Amendola, A.; Fowler, P. J.; Litchfield, R.; Kirkley, S.; Clatworthy, M. // Journal of Knee Surgery (SLACK Incorporated);Jul2004, Vol. 17 Issue 3, p164 

    Presents a study which described the technique used in opening wedge high tibial osteomy using the Puddu plate from Arthrex of Naples, Florida. Materials and methods used; Patient demographics; Indications for surgery; Intraoperative complications recorded; Result of patient satisfaction surveys...

  • Precursor B-Lymphoblastic Lymphoma Presenting as a Solitary Bone Tumor Mimicking Osteomyelitis on MRI. Mika, Joerg; Culton, Lisa Karen; Adler, Claus-Peter; Uhl, Markus; Kersten, Astrid; Knoeller, Stefan Michael // Internet Journal of Pathology;2006, Vol. 5 Issue 1, p4 

    We describe a 22 year-old man with the rare diagnosis of precursor b-lymphoblastic lymphoma involving only the proximal tibia without evidence of leukemia. He presented with right knee pain and swelling of approximately three months duration and nonspecific radiologic findings and was initially...

  • The role of plating in the operative treatment of severe open tibial fractures: a systematic review. Giannoudis, Peter; Papakostidis, Costas; Kouvidis, George; Kanakaris, Nikolaos // International Orthopaedics;Feb2009, Vol. 33 Issue 1, p19 

    Open fractures of the tibial diaphysis are the result of high-energy trauma. They are usually associated with extensive soft tissue loss and represent serious clinical problems. Surgical treatment of these injuries has been associated with substantial complications such as osteomyelitis, delayed...

  • Bilateral asymmetrical Brodie’s abscess. Kurup, Harish V.; Uglow, Mike // European Journal of Orthopaedic Surgery & Traumatology;May2005, Vol. 15 Issue 2, p145 

    Brodie’s abscess is a form of sub-acute pyogenic osteomyelitis. Most of them occur in the metaphysis and respond well to surgical curettage. We report the case of a 15-year-old boy with bilateral asymmetrical Brodie’s abscess of the distal tibia. On the left side, the abscess was...

  • Osteomielitis esclerosante del fémur asociada con trombocitosis. Presentación de un caso. Tavera, Antonio Redón; Franco Espinosa, Ma. de Lourdes; Coria, Elisa Martínez; Ramírez, Rosalba Romero; Chávez, Ricardo Delgado; Morales Osorio, Ma. Guadalupe // Acta Ortopedica Mexicana;mar/abr2008, Vol. 22 Issue 2, p120 

    We present the case of a 13 year-old boy who had chronic sclerosing osteomyelitis of the right femur in whom S. aureus was confirmed as the etiologic agent. Typical picture was apparent after one year period in which there were two hospital admissions. Only soft tissue infection of the right...

  • Retrograde Locked Intramedullary Nailing For The Stabilisation Of Femoral Fractures With Ipsilateral Tibial Fractures (Floating Knee): A Case Report. Yu, Chan Kok; Singh, Vivek Ajit; Chong, Se To Boon // Internet Journal of Orthopedic Surgery;2007, Vol. 4 Issue 1, p7 

    Floating knee is referred to when there is an ipsilateral fracture distal end of femur and proximal tibia. It is considered an orthopaedic emergency as it an unstable situation. Such injuries can lead to kinking or injury of the popliteal artery by the mobile fracture segment. This is so because...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics