Bone transport technique versus induced membrane technique for treatment of infected bone nonunion

Abstract

Objective To compare the clinical outcomes of bone transport technique versus induced membrane technique for treatment of infected bone nonunion. Methods A retrospective study was made on 46 cases of infected bone nonunion admitted from April 2011 to December 2014. They were 33 males and 13 females, aged from 12 to 68 years (mean, 45.3 years), involving 40 tibial and 6 femoral fractures. Bone transport technique was used in 37 cases while 9 cases were treated with induced membrane technique. Fracture union and complications were recorded. The function of the affected limb was evaluated at the final follow-up using Johner-Wruhs criteria. Results The 46 cases were followed up for 9 to 18 months (mean, 14 months). In the bone transport group, bone union was achieved after a mean duration of 6.5 months (range, from 4 to 11 months) without complications like wound infection or neurovascular lesions. In the induced membrane group, bone union was achieved after a mean duration of 5.8 months (range, from 4 to 11 months) and there was one case of reinfection. According to the Johner-Wruhs score system, 34 cases were rated as excellent, 9 as good and 3 as fair, with a total excellent and good rate of 93.5%. Bone transport technique led to 28 excellent, 4 good and one fair cases in the patients with tibial nonunion,and one excellent, 2 good and one fair cases in the patients with femoral nonunion. Induced membrane technique led to 3 excellent, 3 good and one fair cases in the patients with tibial nonunion,and 2 excellent cases in the patients with femoral nonunion. Conclusions Both bone transport technique and induced membrane technique are effective for infected bone nonunion. Bone transport technique may be preferred for tibial infected nonunion while induced membrane technique preferred for femoral infected nonunion. Key words: Tibia; Femur; Fractures, nonuion; Bone grafting