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Levent Eralp - One of the best experts on this subject based on the ideXlab platform.
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knee arthrodesis using a unilateral External Fixator for the treatment of infectious sequelae
Acta Orthopaedica et Traumatologica Turcica, 2008Co-Authors: Levent Eralp, Mehmet Kocaoglu, Ibrahim Tuncay, Erkal F Bilen, Shady Elbeshry SamirAbstract:Objectives: We evaluated the results of arthrodesis using a monolateral External Fixator for the treatment of septic sequelae of the knee joint. Methods: Eleven patients (4 males, 7 females; mean age 60 years; range 29 to 75 years) underwent arthrodesis using a monolateral External Fixator. Indications for arthrodesis were infected total knee prosthesis (n=6), septic arthritis sequelae (n=4), and infected distal femoral tumor prosthesis (n=1). Eight patients had active infection; of these, seven patients initially underwent complete clinical and laboratory eradication of infection with debridement, application of antibiotic-impregnated cement spacer (n=6), and parenteral antibiotics. Resection guides of total knee arthroplasty were used to create wide bleeding femoral and tibial bone surfaces. Biplanar or uniplanar monolateral External fixation was applied for a mean of eight months (range 5 to 12 months). The mean follow-up was 28 months (range 7 to 69 months). Complications were evaluated according to the Paley’s classification. Results: Fusion was achieved in all the patients. There were no recurrent infections. No remarkable shortening developed following the procedure. All the patients could walk without walking aids, except for one patient who further required lengthening for marked shortening due to previous wide tumor resection. Shortening was 3 cm in one patient with infected total knee prosthesis, while it ranged from 1 cm to 2 cm (mean 1.4 cm) in the remaining patients. Pin tract infections were seen in five patients, all of which were successfully treated with oral antibiotics and local wound care. Conclusion: Knee arthrodesis using a monolateral External Fixator is associated with a high fusion rate and a low complication rate, and provides a more comfortable treatment option compared to a circular External Fixator. Key words: Arthrodesis/methods; External Fixators; knee joint/surgery; prosthesis-related infections/surgery.
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distal tibial reconstruction with use of a circular External Fixator and an intramedullary nail the combined technique
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Levent Eralp, Mehmet Kocaoglu, Nazri Mohd Yusof, Murat BulbulAbstract:BACKGROUND: Distal tibial reconstruction with use of an External Fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique. METHODS: Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular External Fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. RESULTS: The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean External fixation time was 3.5 months, and the mean External Fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). CONCLUSIONS: The combined technique is an improvement over the classic External fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of External fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. The Combined Technique” (2007;89:2218-24).
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail surgical technique
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Levent Eralp, Mehmet Kocaoglu, Haroon RashidAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:2137-45).
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem BilselAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137
Mehmet Kocaoglu - One of the best experts on this subject based on the ideXlab platform.
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knee arthrodesis using a unilateral External Fixator for the treatment of infectious sequelae
Acta Orthopaedica et Traumatologica Turcica, 2008Co-Authors: Levent Eralp, Mehmet Kocaoglu, Ibrahim Tuncay, Erkal F Bilen, Shady Elbeshry SamirAbstract:Objectives: We evaluated the results of arthrodesis using a monolateral External Fixator for the treatment of septic sequelae of the knee joint. Methods: Eleven patients (4 males, 7 females; mean age 60 years; range 29 to 75 years) underwent arthrodesis using a monolateral External Fixator. Indications for arthrodesis were infected total knee prosthesis (n=6), septic arthritis sequelae (n=4), and infected distal femoral tumor prosthesis (n=1). Eight patients had active infection; of these, seven patients initially underwent complete clinical and laboratory eradication of infection with debridement, application of antibiotic-impregnated cement spacer (n=6), and parenteral antibiotics. Resection guides of total knee arthroplasty were used to create wide bleeding femoral and tibial bone surfaces. Biplanar or uniplanar monolateral External fixation was applied for a mean of eight months (range 5 to 12 months). The mean follow-up was 28 months (range 7 to 69 months). Complications were evaluated according to the Paley’s classification. Results: Fusion was achieved in all the patients. There were no recurrent infections. No remarkable shortening developed following the procedure. All the patients could walk without walking aids, except for one patient who further required lengthening for marked shortening due to previous wide tumor resection. Shortening was 3 cm in one patient with infected total knee prosthesis, while it ranged from 1 cm to 2 cm (mean 1.4 cm) in the remaining patients. Pin tract infections were seen in five patients, all of which were successfully treated with oral antibiotics and local wound care. Conclusion: Knee arthrodesis using a monolateral External Fixator is associated with a high fusion rate and a low complication rate, and provides a more comfortable treatment option compared to a circular External Fixator. Key words: Arthrodesis/methods; External Fixators; knee joint/surgery; prosthesis-related infections/surgery.
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distal tibial reconstruction with use of a circular External Fixator and an intramedullary nail the combined technique
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Levent Eralp, Mehmet Kocaoglu, Nazri Mohd Yusof, Murat BulbulAbstract:BACKGROUND: Distal tibial reconstruction with use of an External Fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique. METHODS: Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular External Fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months. RESULTS: The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean External fixation time was 3.5 months, and the mean External Fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment). CONCLUSIONS: The combined technique is an improvement over the classic External fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of External fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. The Combined Technique” (2007;89:2218-24).
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail surgical technique
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Levent Eralp, Mehmet Kocaoglu, Haroon RashidAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:2137-45).
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem BilselAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137
Cunyi Fan - One of the best experts on this subject based on the ideXlab platform.
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application of distal radius positioned hinged External Fixator in complete open release for severe elbow stiffness
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Shuai Chen, Yi Zhou, Jiangyu Cai, Shen Liu, Cunyi FanAbstract:Background Radical release for severe stiff elbows may lead to instability. Hinged External fixation is used to treat unstable elbows. We hypothesized that extensive open release combined with a distal radius-positioned hinged External Fixator would have good performance and low complications rate in treating severe elbow stiffness. Thus, the efficacy and security of this technique were assessed in this study. Methods We retrospectively reviewed 38 post-traumatic elbows with severe stiffness that underwent arthrolysis between February 2011 and February 2014. All patients were assessed as having elbow instability after complete arthrolysis. Ligament repair was combined with implantation of a hinged External Fixator (fixed to the humerus and distal radius) to maintain elbow stability. Flexion arc, forearm rotation, Mayo Elbow Performance Score, elbow stability, and radiographs were evaluated preoperatively and postoperatively, and complications were documented. Results Mean follow-up was 31 months. Significant improvement was noted in flexion-extension arc (from 27° to 126°), forearm rotation (from 148° to 153°), and mean Mayo Elbow Performance Score (from 68 points to 96 points). Mean pronation arc decreased from 66° preoperatively to 6° at 1.5 months of follow-up and showed a transient reduction during first 6 months postoperatively. Pin-related infection occurred in 2 patients, which was cured with conservative treatment. Two patients had moderate instability after removal of the Fixator and regained stability at the 12-month follow-up. At the last follow-up, complications included ulnar nerve paralysis in 3, recurrence of heterotopic ossification in 1, and moderate pain in 1. Conclusions Complete open release combined with a distal radius–positioned hinged External Fixator is an effective treatment for severe stiff elbows. This technique had a low complication rate.
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stability of severely stiff elbows after complete open release treatment by ligament repair with suture anchors and hinged External Fixator
Journal of Shoulder and Elbow Surgery, 2014Co-Authors: Shichao Jiang, Shen Liu, Hongjiang Ruan, Cunyi FanAbstract:Background Instability is a crucial issue in severe post-traumatic elbow stiffness during complete-release surgery. This study aimed to evaluate the efficacy of ligament repair using a suture anchor in the operative treatment of severely stiff elbows for which a hinged External Fixator was indicated. Methods We retrospectively reviewed 46 cases of severely stiff elbows (flexion arc Results At a mean follow-up of 24.3 months, the postoperative Mayo Elbow Performance Score was 91 points, as compared with 63 points preoperatively. The mean flexion arc improved from 25° to 126°. Three patients presented with moderate elbow instability when the hinged External Fixator was removed; however, all of them regained stability by the last follow-up. Furthermore, 7 cases of new-onset nerve palsy were noted; however, all of them resolved with conservative management. None of the patients required secondary surgery for any reason. Conclusions Repair of an avulsed collateral ligament with suture anchors and hinged External fixation was effective in restoring functional mobility in patients with severe post-traumatic elbow stiffness after complete release. This could be an option for treating ankylosed, severely or very severely stiff elbows.
Haroon Rashid - One of the best experts on this subject based on the ideXlab platform.
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail surgical technique
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Levent Eralp, Mehmet Kocaoglu, Haroon RashidAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:2137-45).
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem BilselAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137
Kerem Bilsel - One of the best experts on this subject based on the ideXlab platform.
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reconstruction of segmental bone defects due to chronic osteomyelitis with use of an External Fixator and an intramedullary nail
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Mehmet Kocaoglu, Levent Eralp, Haroon Rashid, Kerem BilselAbstract: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 debridement 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 debridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical debridement 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Reconstruction of Segmental Bone Defects Due to Chronic Osteomyelitis with Use of an External Fixator and an Intramedullary Nail” (2006;88:[2137-45][1]). [1]: /lookup/volpage/88/2137
