Infected Nonunion Of Tibia Research Articles

Temporary Intentional Leg Shortening and Deformation to Facilitate Wound Closure Using the Ilizarov/Taylor Spatial Frame

Infected tibial nonunions with bone loss pose an extremely challenging problem for the orthopaedic surgeon. A comprehensive approach that addresses the infection, bone quality, and overlying soft-tissue integrity must be considered for a successful outcome. Acute shortening with an Ilizarov frame has been shown to be helpful in the treatment of open tibia fractures with simultaneous bone and soft-tissue loss. Cases in which the soft-tissue defect considerably exceeds bone loss may require an Ilizarov frame along with a concomitant soft-tissue procedure; however, there are a number of potential difficulties with vascularized pedicle flaps and free tissue flaps, including anastomotic complications, partial flap necrosis, and flap failure. The technique described in this report involves acute shortening and temporary bony deformation with the Ilizarov apparatus to facilitate wound closure and does not require a concomitant soft-tissue reconstructive procedure. Once the wound is healed, osseous deformity and length are gradually corrected by distraction osteogenesis with the Ilizarov/Taylor Spatial frame.

Tibial infected nonunion treated by internal bone transport using the mono-lateral external fixation

To evaluate the clinical and functional outcomes of infected nonunion of the tibia by internal bone transport using the LRS mono-lateral external fixation. From June 2003 to October 2005, twenty-eight patients who underwent internal bone transport for infected nonunion in the tibia were reviewed. Twenty-three cases were open fractures: grade IIIA, 5 cases; grade IIIB, 11 cases; grade IIIC, 7 cases. The other five cases were infected nonunion after internal fixation. The results were evaluated by the classification of the Association for the Study and Application of the Method of Ilizarove (ASAMI) which divided into bone and functional categories. Mean follow-up was 16 months. All the cases got primary bone union, and infection was controlled. Bone results were 14 excellent, 9 good, 2 fair and 3 poor. And functional results were 10 excellent, 13 good, 2 fair and 3 poor. The mean length of time in healing for all patients were 9 months. The mean length of regenerate bone were 6.6 cm. The most common complication was pin infection, and 2 cases refractured at the docking site. Tibial infected nonunion can be successfully treated using the internal bone transport technique.

Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion

Bone grafting plays a critical role in promoting bone healing in infected nonunion, although recurrent infection is of concern. Cancellous bone grafting as an antibiotic delivery system has been reported as an effective method to combat infections. In this study, we report the clinical results of vancomycin-impregnated cancellous bone grafting for the treatment of infected tibial nonunion. Between January 1996 and March 2001, 18 patients with infected tibial nonunion treated with vancomycin-impregnated cancellous bone grafting were available for follow-up. According to the Cierny-Mader classification, all patients belonged to type IVA and IVB osteomyelitis. Adequate debridement, stabilization with external fixation, and staged vancomycin-impregnated cancellous bone grafting were used in all patients. Regular clinical and radiographic follow-ups were conducted. Infection control was obtained in all 18 patients with a 100% infection arrest rate. Bone union was achieved in 13 of 18 patients at an average of 5.8 months. Bone union was obtained subsequently in the remaining five patients after closed nailing in four, and plating and bone grafting in one patient. Radiographs showed good consolidation and hypertrophy of grafted bone at an average follow-up of 48 months. We conclude that vancomycin-impregnated cancellous bone grafting is a safe method for the treatment of infected tibial nonunion.

Treatment of Infected Tibial Nonunions with Debridement, Antibiotic Beads, and the Ilizarov Method

This study of 10 patients presents the early results of a protocol of debridement, antibiotic bead placement, and use of the Ilizarov method with a circular external fixator for treatment of infected nonunions of the tibia in a military population. The nonunions resulted from high-energy fractures in nine cases and an osteotomy in one. The Ilizarov techniques used were transport (five cases), shortening and secondary lengthening (two cases), minimal resection with compression (one case), and resection with bone grafting (two cases). Flap coverage was required for five patients. There were two recurrences of infection (20%) among patients with the most compromised soft tissue. Only 50% of patients were able to perform limited duties while wearing the external fixator. Only four patients returned to active duty; however, three patients from special operations units were able to return to jump status. Six patients underwent medical retirement because of insufficient function, resulting from decreased ankle or knee range of motion and arthrosis or muscle weakness.

The Treatment of Infected Tibial Nonunion with Aggressive Debridement and Internal Bone Transport

Tibial nonunions are a challenging situation for both healing and reconstruction when infection is added. In this retrospective study, we discuss the cases in which we had managed to obtain union by aggressive debridement, circular external fixature, and internal bone transport. Fourteen cases had been treated between January 1995 and December 2000 in the Orthopedics and Traumatology Department of the Gulhane Military Medical Academy. The mean follow-up period was 33.2 (12-60 months) months. The mean length of defects was 4.4 (2.5-8 cm) cm. These defects were repaired by corticotomy and by internal bone transport only. Pseudoarthrosis and union of corticotomy sites occurred in a mean period of 6.8 (4.5-15) months. In two of our patients, reinfection occurred, and hyperbaric oxygen therapy was applied to them. We concluded that in tibial infected nonunions, satisfactory union and control of infection are possible by radical debridement, stable fixation by circular external fixature, osteotomy and callus distraction, antibiotic therapy, and hyperbaric oxygen therapy whenever needed.

Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis of the leg and foot: review of 22 cases.

The efficacy of free composite tissue transfer for the treatment of chronic osteomyelitis of the leg and foot was evaluated in a retrospective study. Twenty-two patients, operated on at the American University of Beirut between January, 1992 and December, 1996, were identified. Infection involved the heel (8), ankle (1), foot (5), and tibia (8). All patients had multiple debridement and prolonged antibiotic treatment prior to presentation. The mean duration of disease was 4.8 years (range: 1 to 25 years). There were five cases of infected tibial non-union and one case of an infected tibial bone defect measuring 15 cm. Following radical debridement, microvascular free-tissue transfer was immediately performed. One latissimus dorsi and 13 rectus abdominis muscle flaps, as well as eight radial forearm fasciocutaneous flaps were used. At a mean follow-up of 3.8 years, there was one rectus abdominis free-flap failure in a Gustilo IIIC tibial fracture, which necessitated secondary amputation; there was no evidence of recurrence of osteomyelitis in the remaining 21 patients during the study period. The patients with tibial nonunion and bone defect healed following resection and bone transport utilizing a callus distraction technique. The results show that free-tissue transfer is a safe and viable treatment option in chronic osteomyelitis of the leg and foot. A brief discussion of the history of microvascular free-tissue transfers, as well as their value in modern reconstructive surgery, is also presented.

Circular frames in the management of infected tibial non-union: a modification of the Papineau technique

We have treated five patients with an infected non-union of the tibia by a modification of the Papineau technique, consisting of a wound microenvironment chamber and bone stabilization with a circular frame. In all cases bone union and elimination of infection was achieved.

Results of Bone Grafting for Infected Tibial Nonunion

Thirty-two patients with infected tibial nonunions were treated, including 24 men and 8 women whose ages ranged from 21 to 72 years (mean, 40 years). Thirty of 32 patients had bone defects < 3 cm. Using the Cierney-Mader classification of osteomyelitis, 11 of 32 (35%) patients were Stage 4A, and 21 of 32 (65%) patients were Stage 4B. All patients had irrigation, debridement, and stabilization using an external fixation device. Twenty-seven (84%) patients had muscle transfers. The time between initial debridement and muscle transfer ranged from 3 to 24 days (mean, 4 days). Bone grafting was performed between 6 weeks and 8 months (mean, 8 weeks) after soft tissue coverage. Patients received intravenous antibiotics for 2 to 6 weeks (mean, 6 weeks). Twenty patients received anterior grafting, 10 received posterolateral grafting, and 2 received both. Followup times ranged from 12 to 49 months (mean, 28 months). Twenty-nine of the 32 (91%) patients had tibial unions between 3 to 10 months (mean, 5.5 months) after bone grafting. The 3 failed tibias united after posterolateral grafting. Infection was controlled in all 32 patients. Autogenous cancellous bone grafting using infection control principles is an effective means to treat infected tibial nonunions.

Infected tibial nonunion. Good results after open cancellous bone grafting in 37 cases.

We treated 37 infected tibial shaft nonunions by debridement followed by open autogenous cancellous bone grafting in a 2-stage procedure. Additional surgery was done in 21 fractures including second debridement before bone grafting and/or a second limited bone grafting and/or a split-thickness skin grafting. All fractures healed after an average of 11 (8-16) months. During 2 years follow-up there were no recurrences of the infection. Two cases of early refracture occurred, both healed following new bone grafting.

The Treatment of Tibial Infected Nonunion by the Ilizarov Method

The Treatment of Tibial Infected Nonunion by the Ilizarov Method

Infections complicating joint replacement and other orthopedic conditions.

The principles underlying the diagnosis and management of infection in the orthopedic patient are well established. Despite this, the patient with an infected implant still presents the orthopedic surgeon with a challenging problem. In this review, I consider the recent developments in the diagnosis and management of the infected arthroplasty, infected tibial nonunions, spinal infections, and disease transmission by bone allografts.

Ilizarov's method in infected tibial pseudarthrosis and for reconstruction of bone defects

The authors describe Ilizarov's method for the treatment of infected tibial pseudarthrosis and for reconstruction of diaphyseal bone defects. This technique was used on 37 patients: 29 cases consisted of infected tibial non-unions without bone defect and 8 cases with consequent bone defect between 2 and 15 cm. Results are variable and less satisfactory than those published by Ilizarov himself or other authors. The late results are better in cases of infected pseudarthrosis without bone defect (79 % bone consolidation, 68 % cure of infection) than in cases with extensive bone defect (44 % bone consolidation, 55 % cure of infection). Ilizarov's method must be considered as very demanding for the patient and also for the surgeon. It is however the only technique for treating simultaneously infection and consolidation.

Comparison of Conventional Treatment vs. Bone Transport for Chronic Infected Tibial Nonunions with Bone Loss

Comparison of Conventional Treatment vs. Bone Transport for Chronic Infected Tibial Nonunions with Bone Loss

Treatment of Infected Nonunion and Delayed Union of Tibia Fractures With Locking Intramedullary Nails

Treatment of infected nonunion of tibial fractures has focused on irradicating infection before attempting to secure union. To secure union in the presence of infection in cases not amenable to conventional treatment, intramedullary nailing combined with open wound management was the treatment in 19 fractures of infected tibial nonunions in 18 patients. Eighteen fractures united. Drainage lessened or ceased after union of fractures and/or removal of nails. Only three cases had bone grafts. All were initially Type III open fractures. The majority occurred in motorcycle accidents. Time to union averaged 6.6 months (range, three to 14 months). Fourteen cases (15 tibias) healed without further drainage; four had minimal but persistent drainage. In properly selected cases, the treatment was safe and effective.

Papineau Technique for Infected Nonunion of Tibia: Clinical Analysis

Papineau Technique for Infected Nonunion of Tibia: Clinical Analysis

Management of Infected Tibial Nonunions With Sequestration in the Dog

Osteomyelitis with sequestration of large fragments of cortical bone accompanied delayed union‐nonunion in the tibia of three dogs. All fracture sites were grossly unstable at initial presentation, with the sequestration creating large bony deficits that required bone grafting. All three fractures were treated by the application of external fixation, seques‐trectomy, debridement, cancellous bone grafting, and dependent wound drainage. One animal refractured the tibia causing an exacerbation of the osteomyelitis. Reapplication of an external fixation frame and direct current electrical stimulation resulted in bony union. There were no recurrences of infection on long‐term follow‐up in any of the three tibias.

External Fixation: The Current State of the Art

This book includes, first, a concise review of different external fixators, biomechanical analysis of this device, and the biomechanics of fracture healing. The indications, technical considerations, and complications are discussed. The clinical application of the external fixator is discussed in detail, which includes tibial fractures (closed and open), pelvic fractures, multiple fractures, nonunion, and infected nonunion. The Hoffmann apparatus is discussed also, and clinical data on its use are presented. The use of external fixators in the management of fractures is an old concept, but recently the popularity of this method has returned, especially in open fractures or in severely comminuted fractures. There is no doubt that this principle is a sound one, and every orthopedic surgeon should be well versed in its use. This book presents the necessary information.

A few attempt treating four cases of infected non union of tibia

Four cases of infected nonunion of tibia were treated in our clinic in recent five years. All cases had been treated in another hospital. After debridement and sequestrectomy in all cases, three methods were chosen.1. Extra skeletal fixation using methyl methacrylate to gain immobilization.2. Bathing affected whole leg in medicated water for the case with wide skin defect.3. Intramedullary fixation using Kuntscher nail with transverse screws.