Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques


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According to ASAMI classification, bone results and functional results were evaluated, and the details are listed in Tables 2 and 3.

Bone transport techniques in posttraumatic bone defects - EM|consulte

All the patients had a feeling of pain during the distraction period, but they could have tolerated the pain by oral analgesics. Pin-track infection occurred in 70 patients which. Figure 1 A year-old man who had infected tibia nonunion. A This is a year-old man who had infected tibia nonunion with soft tissue defected and foot drop. B It shows the picture in operation.

Nonunion of the Long Bones

C Debridement of the site of infected nonunion with 4-cm bone defects and corticotomy of tibia. D Two weeks after operation with bone transport. E Four weeks after operation with bone transport. F Six weeks after operation, bone ends contacted with each other at the docking site and the regenerated bone had begun to be mineralized.

G Three months after operation, foot drop was corrected and the frame of foot was removed. H Five months after operation, good consolidation of the regenerate and complete bone union at the docking site was presented. I Seven months after operation, it shows complete bone union, and the apparatus was removed.

Figure 2 A year-old man who had an infected femur nonunion. A Radiograph of a year-old man who had an infected femur nonunion. B Debridement of the site of infected nonunion with 8-cm bone defects and corticotomy of femur. C Two months after operation with bone transport. D Twelve months after operation, good consolidation of the regenerate and complete bone union at the docking site was presented.

E The externalfixator was removed at 12 months after operation. Sixty-six patients had only local inflammation, and they were treated by pin care and empirical broad spectrum antibiotics for oral administration; four patients had a purulent drainage, and aspiration of pus were cultured for selecting sensitive antibiotics, and finally they were treated by intravenous sensitive antibiotics. Thirty-two patients had the axial deviation during bone transport including 20 infected tibias nonunion and 12 infected femur nonunion, and external fixator adjustments for.

Bone grafting was required in 12 patients which involved 7 infected tibia nonunion and 5 infected femur nonunion at the docking site.

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Loosening of wires or pins occurred in 8 patients involving 4 infected tibia nonunion and 4 infected femur nonunion. The loose wires were re-tensioned, and the loose pins which are due to loss of adhesion with bone were removed and the new pins were inserted. Two patients with infected tibia nonunion suffered refracture at the docking site after removal of the external fixator, and. There were no neurovas-cular complications or a compartment syndrome. This is a retrospective study of bone transport in the treatment of the largest number of patients with infected nonunion of tibia and femur at present.

The present study showed that infected nonunion of tibia and femur treated by bone transport acquired satisfied results. The excellent and good rate of bone results was All the patients achieved bone union and no recurrence of infection was observed. In order to further demonstrate the effectiveness of Ili-zarov methods and give a better guideline for clinical treatment of infected nonunion, we conducted a systematic review of infected nonunion of tibia and femur treated by Ilizarov methods.

The initial literature search identified relevant records, and finally 22 studies and a total of patients were included in the systematic review [2,13,]. Mean age, mean bone defects, bone union, bone results, functional results, complications per patient, external fixation time, external fixation index, and amputation rate were recorded and statistically analyzed using weighted means based on the sample size in each study by SPSS The following data were calculated: The mean age was More details are listed in Table 4.

In our study, the complications per patient were 1. We believed that making full preparations for the surgery based on specific conditions of every patient, meticulous postoperative care, and patients' good compliance could decrease the complication rates. The most common complication was pin-track infection, and the incidence was Although we paid more attention to pin-track care, there was still a high incidence. Therefore, in addition to pin-track care, we recognized that pin-track infection was also related to patient's bone quality, immunity, and so on.

The rate of axial deviation during bone transport was The complication could be corrected by external fixator adjustments. We considered that the reason was overload of weight bearing or excessive functional exercise, and it may be avoided by reasonable rehabilitation exercises. There is a controversy on regular bone grafting at the docking site. We did not perform regular bone grafting, and bone grafting was required in only 12 patients The rates of loosening of pins and refracture were 7. Good and excellent rate in bone results was In our experience, the infected union of femur is more suitable for bone transport by monolateral external fixa-tor due to the extensive soft-tissue envelope around the femur and the neurovascular structures.

Monolateral external fixators for bone transport are simple in design and application and easy to carry out during a surgical procedure while maintaining it, and it can also alleviate pain caused by pin during the distraction period compared to the Ilizarov external fixator. The infected tibia.

In addition, some important aspects of bone transport should be paid attention. This is the key step to control bone infection. If regenerate quality is poor, the speed of distraction will slow down. In conclusion, our study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied effects in bone results and functional results.

behighmehrcar.ml However, our study lacks a direct comparison with any other treatment options, further randomized controlled trials are needed to draw more valuable conclusion. PY performed the design and conception of the research, collected and analyzed the data, and drafted the manuscript. LZ joined the design and conception of the research and revised the manuscript critical for important content. TL joined the design of the research, and collected the data and underwent data analysis. LZ joined the design and conception of the research. JZ joined the conception of the research.

QZ performed operations, joined the design and conception of the research, and drafted the manuscript. PT performed the design and conception of the research, analyzed the data, drafted the manuscript, and gave some precious comments in revising the manuscript. All authors read and approved the final manuscript.


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Our authors would like to thank all patients included in the research, and all nurses and doctors in our department. This study was supported by the National Natural Science Foundation of China ; ; Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions - a prospective study.


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  • Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques.
  • J Trauma Manage Outcomes. Management of nonunion of lower-extremity long bones using mono-lateral external fixator-Report of 37 cases. The rates of loosening of pins and refracture were 7. Good and excellent rate in bone results was In our experience, the infected union of femur is more suitable for bone transport by monolateral external fixator due to the extensive soft-tissue envelope around the femur and the neurovascular structures.

    Background

    Monolateral external fixators for bone transport are simple in design and application and easy to carry out during a surgical procedure while maintaining it, and it can also alleviate pain caused by pin during the distraction period compared to the Ilizarov external fixator. The infected tibia is more suitable for bone transport by the Ilizarov external fixator, because Ilizarov external fixators for bone transport can provide a stable mechanical environment, correct deformities, and enable weight bearing during the course of treatment, and the patients can also tolerate the pain caused by tensioned wires of Ilizarov external fixators.


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    In addition, some important aspects of bone transport should be paid attention. This is the key step to control bone infection.

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    If regenerate quality is poor, the speed of distraction will slow down. In conclusion, our study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied effects in bone results and functional results. However, our study lacks a direct comparison with any other treatment options, further randomized controlled trials are needed to draw more valuable conclusion. Jain AK, Sinha S.

    Infected nonunion of the long bones. Clin Orthop Relat Res. Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions - a prospective study. J Trauma Manage Outcomes. Management of nonunion of lower-extremity long bones using mono-lateral external fixator—Report of 37 cases. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod.

    J Orthop Trauma.

    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
    Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques

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