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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 24, 2022
Accepted:
September 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
