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Treatment of tibial large bone defects: A comparative study of bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate

  • Author Footnotes
    1 First author of the manuscript, Yibo Xu and Teng Ma contributed equally to this manuscript
    Yibo Xu
    Footnotes
    1 First author of the manuscript, Yibo Xu and Teng Ma contributed equally to this manuscript
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
    Search for articles by this author
  • Author Footnotes
    1 First author of the manuscript, Yibo Xu and Teng Ma contributed equally to this manuscript
    Teng Ma
    Footnotes
    1 First author of the manuscript, Yibo Xu and Teng Ma contributed equally to this manuscript
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
    Search for articles by this author
  • Cheng Ren
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Ming Li
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Yao Lu
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Liang Sun
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Qiang Huang
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Qian Wang
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Hanzhong Xue
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Zhong Li
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Kun Zhang
    Correspondence
    Corresponding author.
    Affiliations
    Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi′an 710054, China
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  • Author Footnotes
    1 First author of the manuscript, Yibo Xu and Teng Ma contributed equally to this manuscript
Published:September 24, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.042

      Highlights

      • Ilizarov technique usually requires long-term placement of external ring fixators for consolidation in the treatment of tibial large bone defects which results in a variety of complications.
      • Modified Ilizarov techniques have been tried to shorten the duration of external fixation to avoid the related complications and improve the quality of life for the patients.
      • Bone transport under the guidance of intramedullary nail could reduce the period of external fixation, guarantee the length and alignment of the regenerated bone, improve the comfort of patients and allow early removal of the external fixator, weight bearing and rehabilitation.

      Abstract

      Purpose

      To compare the bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate for the treatment of tibial large bone defects.

      Methods

      A retrospective analysis was conducted by enroling 33 surgically treated patients with tibial large bone defects after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic orthopaedic Department, Xi'an Honghui Hospital from January 2018 to January 2021. All the patients were categorized in Group A (transport over intramedullary nail, 12 cases) and Group B (transport alone, 21 cases) based on the surgery strategy. The collected clinical materials and data included gender, age, injury mechanism, smoking habits, comorbidity diseases, initial fracture type (open or close), bone defect size, surgical duration, intraoperative bleeding loss, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, weight bearing time, complications and Paley bone and functional criteria.

      Results

      Thirty-three patients were enroled and successfully followed up with an average time of 15.25±4.31 months ranged from 8 to 21 months in Group A and an average time of 17.09±5.64 months ranged from 9 to 31 months in Group B. No significantly statistical differences of the demographic data were discovered between the two groups. There were no significantly statistical differences of the average bone defect size, intraoperative bleeding loss, resorption time of calcium sulphate and bone transport time between the two groups. However, the average surgical duration (P = 0.002) was significantly longer in Group A than Group B and the average external fixation time (P<0.001), external fixation index(P = 0.002) and weight bearing time (P = 0.030) were significantly shorter in Group A than Group B. No significantly statistical difference of excellent and good rate of bone outcomes and complication rate was observed, however, the excellent and good rate of functional outcomes (P = 0.041) was significantly higher in Group A than Group B.

      Conclusion

      Compared with the conventional Ilizarov technique combining with antibiotic-impregnated calcium sulphate for large tibial bone defects, bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate had favourable external fixation time, external fixation index, weight bearing time and clinical functional outcomes which effectively suppressed the infection and allowed patients earlier removal of the external fixator and weight bearing for rehabilitation.

      Keywords

      Abbreviations:

      CPM (Continuous Passive Motion), CS (Calcium Sulphate), EFI (External Fixation Index), PMMA (Polymethyl Methacrylate)
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