Abstract
BackgroundThe purpose of this study was to evaluate the outcomes of bifocal bone transport in the treatment of femoral bone defects caused by infections.MethodsClinical and radiographic data of patients with infected femoral nonunion treated by the bifocal bone transport at our hospital were analyzed retrospectively, from January 2008 to December 2019. Depending on the location of bone defects, the patients were divided into three groups (proximal, intermediate, and distal). The Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria was applied to assess the bone and functional outcomes. Postoperative complications of three groups were documented and compared.ResultsSeventy-six cases of infected femoral bone defects (31 cases of proximal, 19 cases of intermediate, and 26 cases of distal) were managed by bifocal bone transport successfully with a mean follow-up time of 30.8 months (range, 23 to 41 months). There were 58 men (76.3%) and 18 women (23.6%), with a mean age of 38.8 years (range, 23 to 60 years). The bone union was received in 76 cases with a mean of 6.9 months (range, 5 to 8 months). Pin tract infection was observed in twenty-nine cases (38.1%), 7 cases (9.2%) of muscle contractures, 3 cases (7.9%) of joint stiffness, 13 cases (17.1%) of axial deviation, 2 cases (2.6%) of delayed union, one case (1.3%) of nonunion, and none (0%) of transport gap re-fracture. One patient (1.3%) was scheduled for knee arthroplasty when bone transport treatment ended.ConclusionsBone transport using an external rail fixator was a practical method to treat the femoral bone defects, since the satisfactory rate of bone union and limb function recovery. Complications of distal femoral bone transport were more severe than the proximal and intermedia, but the rate of complication was the least of the three groups. Soft-tissue-related complications were more likely to occur in the intermediate bone transport.
Highlights
The purpose of this study was to evaluate the outcomes of bifocal bone transport in the treatment of femoral bone defects caused by infections
The purpose of this study was to evaluate the efficacy of bifocal bone transport in the treatment of femoral defects caused by infection, and the complications of different locations’ bone transport were compared for avoiding the potential risks
Study design After receiving the written informed consent from participants and approval from our hospital’s Ethics Committee, the medical records and radiographs were evaluated retrospectively of all patients whose infected femoral bone defect treated by single-level bone transport using a unilateral external rail fixator (Orthofix limb reconstruction system, Verona, Italy), from January 2008 to December 2019
Summary
The purpose of this study was to evaluate the outcomes of bifocal bone transport in the treatment of femoral bone defects caused by infections. Femoral bone defects caused by the infection have still been a tricky problem for orthopedic surgeons, which is commonly brought out by open fracture and chronic osteomyelitis [1,2,3,4,5]. Bone transport based on the principle of distraction osteogenesis, pioneered by Ilizarov, has gradually become the practical choice for orthopaedic surgeons to treat infected femoral nonunion. Of this technique, all possible pathologies can be resolved simultaneously, including infection, defects, length, alignment, and soft tissue problems. The structure of the unilateral framework is not stable enough, which requires exquisite preoperative design and postoperative care to prevent potential complications, such as pin tract infection, axial deviation, soft tissue contracture, joint stiffness, etc
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