Abstract
ObjectiveTo evaluate clinical outcomes of the application of induced membrane followed by trifocal bone transport technique in the treatment of massive tibial defect caused by osteomyelitis.MethodA total of 18 eligible patients with tibial defect > 6 cm caused by osteomyelitis who were admitted to our institution from January 2010 to January 2016 and treated by induced membrane followed by trifocal bone transport technique. There were 12 male and 6 females with an average age of 40.4 years old. A detailed demographic data (age, sex, etiology, previous operation time, defect size and location, interval from Masquelet technique to trifocal bone transport technique, external fixation index (EFI), duration of regenerate consolidation and docking union) were collected, bone and functional outcomes were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during and in the period of follow up were recorded and evaluated by Paley classification at a minimum follow-up of 2 years.ResultsThe etiology include posttraumatic osteomyelitis in 13 cases and primary osteomyelitis in 5 cases. An average of previous operation time was 3.4 times. Mean tibial defect after radical debridement was 6.8 cm. An average interval duration from formation of induced membrane to trifocal bone transport was 4.8 weeks. An average of EFI was 37.1 days/cm, the duration of regenerate consolidation and docking union were 124.7 days and 186.4 days, respectively. An average time of follow-up after removal of external fixator was 28.5 month without recurrence of osteomyelitis. The bony outcome was excellent in 6 cases, good in 8 cases, fair in 3 cases and poor in 1 case, and functional outcome was excellent in 4 cases, good in 10 cases, fair in 2 cases and poor in 2 cases. The most common complication was pin tract infection which occurred in 15 cases and there were no major complications such as nerve or vascular injury.ConclusionMassive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes.
Highlights
Management of tibial defect caused by primary or secondary osteomyelitis is a challengeable troublesome situation, even for skillful and experienced orthopedic and plastic surgeon, especially massive defect (> 6 cm) associated with soft tissue loss which compromised the surrounding envelope of blood supply for bone healing and result in “chaotic” condition requires individualized strategic reconstructive approach to reach expected clinical outcomes [1]
Massive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes
Several treatment options have been proposed and stood the test of time in the reconstruction of long bone defect, current treatment techniques range from autologous bone grafting, Masquelet technique, Ilizarov technique based on distraction osteogenesis, free vascularized or non-vascularized fibular grafting, depending on the anatomical location and size of the defect as well as associated injuries [2,3,4,5,6,7,8,9,10]
Summary
Management of tibial defect caused by primary or secondary osteomyelitis is a challengeable troublesome situation, even for skillful and experienced orthopedic and plastic surgeon, especially massive defect (> 6 cm) associated with soft tissue loss which compromised the surrounding envelope of blood supply for bone healing and result in “chaotic” condition requires individualized strategic reconstructive approach to reach expected clinical outcomes [1]. Masquelet technique was firstly introduced in 1986 and gained its popularity in the reconstruction of bone defect by separated two stage with satisfied clinical outcomes [11]. Ilizarov bone transport technique based on distraction osteogenesis have been applied in treatment of bone defect, especially in cases associated with soft tissue loss given its naturally advantages of simultaneous histogenesis result in expected treatment outcomes. Combination of Masquelet technique and Ilizarov bone transport (bifocal) technique have been reported and approved its usefulness in the successful reconstruction of bone defect [12,13,14,15,16]
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