Bone transport technigue using mono-lateral external fixator plus bone grafting for treatment of posttraumatic chronic osteomyelitis of lower limbs

Abstract

Objective To review the results of bone transport using a unilateral external fixator plus autografts for treatment of posttraumatic chronic osteomyelitis of lower limbs. Methods A retrospective analysis was made of 18 patients sustaining posttraumatic chronic osteomyelitis following femoral or tibiofibular fracture between September 2008 and September 2014. After bone transport with a unilateral external fixator in all, 9 had autologous ilium bone grafting and plate osteosynthesis. Ossification of new bone was assessed by bone healing index(BHI). Outcome was assessed by Paley score. Results At the follow-up of 10-24 months (mean, 13.5 months), union was achieved and infection was eradicated in all patients. Period of bone union was (46.3±10.3)weeks in all, but a relatively much shorter period of time [(41.4±10.4)weeks] was observed in patients with autologous bone grafting. Duration from bone transport to removal of external fixator was (42.9±13.0)weeks in all, and was (34.7±11.8)weeks in patients with autologous bone grafting. BHI was (1.9±0.6)m / cm in all, and was (1.4±0.4)m/cm in patients with autologous bone grafting. According to the Paley score, bone results were excellent in 15 patients and good in 3 patients, and functional results were excellent in 9 patients, good in 6 patients and fair in 3 patients. Pin-tract infection occurred in 5 patients, bone infection in 3, delayed union in 2, stiff joints in 3, and pin adjustment in 5(including 3 malunions). Conclusions Bone transport using a unilateral external fixator is an effective treatment procedure for posttraumatic chronic osteomyelitis. After bone transport, autologous ilium bone grafting and plate osteosynthesis is a feasible method to shorten the external fixation time and total hospital length of stay. Key words: Osteomyelitis, traumatic; Bone lengthening; Bone transplantation