Novel piston technique versus Ilizarov technique for the repair of bone defect after lower limb infection

Jiafei Du,Pengfei Cheng,Zifei Yin,Hao Shen,Pei Han

doi:10.1186/s13018-021-02844-1

Abstract

BackgroundWe aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection.Patients and methodsWe retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. There were 38 men and three women with a mean age of 43.41 (range, 12–69 years). The infected bone defects involved 36 tibias and five femurs. The piston technique (PT, group A) was used in 12 patients and the Ilizarov technique (IT, group B) in 29 patients. The mean follow-up period was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate bone healing and functional recovery.ResultsComplete eradication of the infection and union of docking sites were accomplished in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between groups A and B (p = 0.558) (excellent [9 vs. 19], good [3 vs.10]); group A showed better functional outcomes than group B (p < 0.05) (excellent [7 vs. 6], good [4 vs. 12], fair [0 vs. 10] and poor [1 vs. 1]). Pain was the most common complaint during follow-up, and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8), and delayed healing of the joint (0 vs. 3).ConclusionsSatisfactory bone healing can be achieved by using both PT and IT, although PT demonstrated better functional results, lower EFI, and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation.

Highlights

Infectious bone defects of the lower extremity pose a huge challenge for doctors in clinical practice due to their complicated treatment and unfavorable prognosis
Satisfactory bone healing can be achieved by using both period was 28.50 months (PT) and Ilizarov technique (IT), PT demonstrated better functional results, lower external fixation index (EFI), and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation
The inclusion criteria for this study were: (1) osteomyelitis diagnosed by bacteriology or histology following intraoperative biopsy based on clinical manifestations and imaging; (2) patients treated with the PT or IT; (3) bone defect > 2.5 cm after debridement; and (4) age < 70 years

Summary

Introduction

Infectious bone defects of the lower extremity pose a huge challenge for doctors in clinical practice due to their complicated treatment and unfavorable prognosis. A high value has been placed on the Masquelet technique [13, 14], and it is widely used It is, a two-stage surgical technique, which involves debridement and filling of the bone defect with cement spacer in the first stage to control postoperative infection, followed by bone remodeling by filling with cancellous bone after removing the cement inside the socalled induced membrane in the second stage. In some cases, several bone grafts are needed, and donor site injury can occur To overcome these technical limitations, our department used the Masquelet technique combined with the Ilizarov bone transport technique, which is called the piston technique, for the first time to treat bone defects after lower extremity infection. We aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection

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