Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series.

Gianluca Testa,Giuseppe Sessa,Danilo Costa,Vito Pavone,Domenico Costantino Aloj,Andrea Vescio,Luca Gurrieri,Giacomo Papotto

doi:10.3390/jcm9051352

Abstract

Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.

Highlights

The Ilizarov external fixation technique has been used for the last five decades for the management of long-bone infected nonunions
This method uses percutaneously-inserted fine wires which are tensioned to provide a stiff and stable frame construct [1,2,3,4,5,6]. It permits the realization of compression, distraction, bone-lengthening, and deformity correction. It is a valid alternative treatment compared to internal fixation, especially when internal fixation can be complicated by bone loss, deformity, or failure of previous internal fixation [7]
In seven patients (26.9%), the S53P4 bioactive glass was used for filling the residual bone gap

Summary

Introduction

The Ilizarov external fixation technique has been used for the last five decades for the management of long-bone infected nonunions This method uses percutaneously-inserted fine wires which are tensioned to provide a stiff and stable frame construct [1,2,3,4,5,6]. Bone infection treatment after intramedullary nailing usually includes several surgical procedures, including removal of fixation devices, radical bone debridement with reaming of the canal, deep tissue sampling, elimination of infected bone, and/or insertion of local antibiotic delivery systems In these cases, application of the Ilizarov external fixator is useful even when there are significant soft tissue defects, which are often treated with musculocutaneous flaps. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications

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Conclusion