Ilizarov bone lengthening and bone transport technique for treatment of chronic posttraumatic osteomyelitis of lower-extremity long bones

Abstract

Objective To investigate the therapeutic effect of chronic posttraumatic osteomyelitis of lower-extremity long bones treated by bone lengthening and bone transport with the Ilizarov method. Methods From January 2005 to December 2012, 42 cases of chronic posttraumatic osteomyelitis of lower-extremity long bones were treated using Ilizarov bone lengthening and bone transport technique, including 13 cases of femur infection and 29 cases of tibia infection. Thirty cases were treated by debridement, compression of the fracture end and bone lengthening and 12 cases by debridement and bone transport. Results All the patients received a follow-up of 12 to 48 months [(15.0 ± 4.5) months]. Infection obtained one-stage control in 38 cases, but the infection was not controlled in 4 cases until 1-3 more debridement. For the 30 cases undergoing compression-distraction, 26 healed in one-stage and 4 nonunion healed after additional autogenous bone grafting. Twelve cases treated by bone transport healed after additional surgery of fracture gap cleaning and autogenous bone grafting.Length of bone lengthening was 2.5-11.0 cm (mean, 4.5 cm). After bone healing, shortening of the lower limb compared to the normal side was less than 2.5 cm in 36 cases, 2.5-3.0 cm in 4 cases, and 3.0-4.5 cm in 2 cases. Eight cases were detected with pin-tract infection, but healed by drainage or replacement of external fixation pins. There was no further bone infection. Three cases had loosening of external fixation pin and the pins were replaced. Conclusion Ilizarov bone lengthening and bone transport technique have advantages in the treatment of chronic posttraumatic osteomyelitis of lower-extremity long bones, but postoperative active rehabilitation and close observation are needed to prevent complications of joint dysfunctions, pin tract infection and pin loosening. Key words: Osteomyelitis; Ilizarov technique; Bone transport