Clinical strategies at the docking site of distraction osteogenesis: are open procedures superior to the simple compression of Ilizarov?

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Abstract

[Indexed for MEDLINE] 11. Injury. 2017 Oct;48(10):2276-2284. doi: 10.1016/j.injury.2017.07.018. Epub 2017 Jul 12. Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects. Tetsworth K(1), Paley D(2), Sen C(3), Jaffe M(4), Maar DC(5), Glatt V(6), Hohmann E(7), Herzenberg JE(8). Author information: (1)Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia. (2)Paley Institute, St. Mary's Hospital, West Palm Beach, FL, USA. (3)Department of Orthopaedic Surgery, Medical School of Istanbul, University of Istanbul, Istanbul, Turkey. (4)Wellstar Health System, OrthoAtlanta private practice group, Atlanta, GA, USA. (5)Department of Orthopaedic Trauma, St. Vincent's Hospital, Indianapolis, IN, USA. (6)Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; University of Texas Health Science Center, San Antonio, Texas, USA. (7)University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; Musculoskeletal Research Unit, Central Queensland University, Rockhampton, QLD, Australia. Electronic address: ehohmann@hotmail.com. (8)International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA. INTRODUCTION: This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length. METHODS: In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates. RESULTS: The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28). CONCLUSIONS: While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures. LEVEL OF EVIDENCE: Level III; Retrospective comparative study. Copyright © 2017 Elsevier Ltd. All rights reserved. DOI: 10.1016/j.injury.2017.07.018