Abstract
A series of cases of reamed intramedullary nailings carried out after complications in regenerated bone and docking site had occurred in bone transport is presented here. Nine patients (femur = 5; tibia = 4) had treatment with resection after open fractures or infection and underwent bone transport. The mean length of regenerated bone was 9.5 cm (range 6–18 cm). After bone transport, the fixator remained in place for a mean period of 12.8 months (range 8–24 months). In six cases (femur 4; tibia 2), the thickness of the cortical wall of the regenerate column was insufficient, and in two of these, there was, in addition, nonunion of the docking site. In the two tibial cases, nailing was carried out shortly after the fixator had been removed and after refracture of the regenerated bone had occurred due to insufficient cortical thickness. In one femur, nailing was carried out for nonunion of the docking site. Follow-up involved clinical and X-ray checks. The mean follow-up was 3.9 years (range 2–6 years). In all cases, union and with complete corticalization of the regenerate column was observed at an average 6 months after nailing (range 4–11 months). Infection occurred in one tibia 4 months after nailing. The infection was treated with antibiotics, and the nail was subsequently removed. We conclude that nailing is a potential solution for regenerated bone and docking site problems but, if used after prolonged periods of external fixation, may necessitate antibiotic therapy for at least 10 days after the fixator has been removed.
Highlights
Bone transport for segmental resections in the treatment for infected nonunion, osteomyelitis, or after bone loss in open fractures remains a major undertaking for orthopedic surgeons [1,2,3,4]
A series of cases of reamed intramedullary nailings carried out after complications in regenerated bone and docking site had occurred in bone transport is presented here
Bone transport using a monolateral external fixator achieves a similar result through distraction of callus that is obtained from a subperiosteal osteotomy [27]
Summary
Bone transport for segmental resections in the treatment for infected nonunion, osteomyelitis, or after bone loss in open fractures remains a major undertaking for orthopedic surgeons [1,2,3,4]. For long-bone diaphyseal defects larger than 5 cm, with or without a soft-tissue defect, specialized management is needed [5]. Bone transport with a circular or monolateral external fixator represents a standard method for managing lower limb bone defects and for limb lengthening [11,12,13,14]. These methods induce two biological processes: distraction osteogenesis, the new production of bone from a corticotomy, and transformational osteogenesis, where the mechanical stimulation of an abnormal bony interface regenerates normal bony continuity and achieves consolidation [15, 16]. There is less soft-tissue transfixation by pins, thereby
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