Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol.

Abstract

Although bone transport is generally accepted as the gold standard for the treatment of segmental septic bone defects, some aspects of its practical application are still open to debate. We present our results in this field and compare them with the series published so far. We reviewed all our patients (2010-2018) that underwent a bone transport procedure in the lower limb due to a septic bone defect. We calculated the bone healing index (BHI), the external fixation index (EFI), the rate of complications and the clinical results. We statistically compared our results with 63 publications with a similar scope. Thirty-five patients (30M/5F) with a mean age of 40years and a mean follow-up of 45months were included. Bone segment was 24T/11F and mean defect was 8.4cm (7.34T/ 10.73F). Mean global BHI was 45.62days/cm (48.16T/40.09F). Mean EFI was 2.37months/cm. Results were excellent in 9 patients, good in 23 and bad in 3. Bone graft was used in 60% of the cases. The size of our series is similar to previously published ones, although the mean age of our patients is higher and they present a larger bone defect. BHI of our series is similar to that of other series, although EFI is significantly higher. The number of complications is also in line with the existing literature. The use of a two-stage technique for managing segmental bone defects of septic origin in the lower extremity is a valid alternative. Our series shows results comparable to the current literature.