Infected nonunion of tibia and femur treated by bone transport.

Peng Yin,Licheng Zhang,Peifu Tang,Jianfeng Zhou,Lihai Zhang,Qun Zhang,Jiantao Li,Jianheng Liu,Tongtong Li,Guoqi Wang

doi:10.1186/s13018-015-0189-5

Peng Yin, Licheng Zhang + Show 8 more

Open Access

https://doi.org/10.1186/s13018-015-0189-5

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Abstract

ObjectiveThe objective of this study was to evaluate the effectiveness of the treatment of infected nonunion of tibia and femur by bone transport.Material and methodsWe retrospectively reviewed 110 patients with infected nonunion of tibia and femur treated by bone transport. Our study included 92 males and 18 females with a mean age of 38.90 years. The site of infected nonunion involved 72 tibias and 38 femurs. The mean length of the bone defects after radical debridement was 6.15 cm (range 3–13 cm).ResultsThe mean follow-up after removal of the apparatus was 23.12 months (14–46 months). Ten patients including seven patients with infected tibia nonunion and three patients with infected femur nonunion were lost to follow-up. All the patients achieved bone union, and no recurrence of infection was observed. The time of bone transport took a mean of 67.50 days (range 33 to 137 days), and the mean external fixation index was 1.48 months/cm (range 1.15–1.71 months/cm). According to Association for the Study and Application of the Method of Ilizarov (ASAMI) classification, bone results were excellent in 68, good in 28, fair in 12, and poor in 2; functional results were excellent in 37, good in 42, fair in 21, and no poor.ConclusionsOur study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied results. Radical debridement is the key step to control bone infection.

Highlights

Infected nonunion of tibia and femur are common in clinical practice
Our study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied results
We presented our experience in the treatment of infected nonunion of tibia and femur by bone transport using Ilizarov external fixator and monolateral external fixator, respectively

Summary

Introduction

Infected nonunion of tibia and femur are common in clinical practice. Some coexisting problems usually complicate the nonunion including persistent infection, bone and soft tissue loss, limb-length inequalities, deformity, and joint stiffness [1,2]. Heretofore, there has still been a challenge for orthopedic surgeons about the treatment of infected nonunion of tibia and femur [3,4,5]. Several different surgical treatment options have been proposed, including bone grafting [6], free tissue transfer [7], antibiotic cement [4], and Ilizarov methods [8]. There are some limitations in bone grafting, such as the size of bone defects, donor site morbidity, and extended graft incorporation time [9].

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