Primary segmental debridement and bone transport for tibial infective nonunion

Abstract

Objective To observe the clinical outcomes of primary segmental debridement and bone transport in the treatment of tibial infective nonunion. Methods From August 2008 to August 2011, we used primary segmental debridement and bone transport to treat 15 patients with tibial infective nonunion. They were 12 males and 3 females, with an average age of 36.9 years (from 20 to 55 years). Treatment procedures included segmental resection of the infection site, proximal tibial metaphyseal osteotomy, bone transport, opening infected wounds, bone graft and debridement for docking site. We divided the treatment process into 4 stages: stage I (from admission till the primary operation), stage Ⅱ (from bone transport till the gap disappeared), stage Ⅲ (from docking site manoeuvre till removal of the external fixator), and stage Ⅳ (from removal of the external fixator till 2 years postoperation). Complications during the follow-up were recorded. Scores of physical component summary (PCS) and mental component summary (MCS) in SF-36 and the visual analogue scale (VAS) were recorded during the 4 stages. Bone healing index and surgical frequency were calculated for each patient. Results Of all the patients, one was followed up until removal of the external fixator, and 14 of them (93%) until 2 years after removal of the external fixator. After debridement the tibial defects averaged 7.5 cm (from 3 to 12cm). The healing index was 43.1 d/cm (from 33 to 62 d/cm). The surgical treatment time averaged 48 weeks (from 30 to 62 weeks). The PCS, MCS and VAS scores of stage I were significantly higher than those of stages Ⅱ & Ⅲ but significantly lower than those of stage Ⅳ(P < 0.05); the PCS, MCS and VAS scores of stage IV were significantly higher than those of stages Ⅱ & Ⅲ(P < 0.05). The 15 patients received a total of 23 operations, averaging 1.5 times per patient. Conclusions Although primary segmental debridement and bone transport is a time-consuming treatment of tibial infective nonunion which may lead to many complications, it can restore physical function and psychosocial health. In addition, the treatment has advantages of limited operation frequency, short fixation time and radical control of bone infection. Key words: Tibia; Bone diseases, infectious; Bone lengthening; Bone defect