Acute shortening versus bone transport for the treatment of infected femur non-unions with bone defects.

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Abstract

[Indexed for MEDLINE] 17. J Clin Orthop Trauma. 2023 Sep 22;44:102255. doi: 10.1016/j.jcot.2023.102255. eCollection 2023 Sep. Limb salvage and functional recovery in infected nonunion of the distal tibia treated with the Ilizarov techniques. Shastov AL(1), Mikhailov AG(2), Kliushin NM(3), Malkova TA(4). Author information: (1)Orthopaedic Surgeon, Bone and Joint Infection Clinic Department # 3, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia. (2)Orthopaedic Surgeon, Head of Bone Infection Clinical Department # 3, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia. (3)Orthopaedic Surgeon, Bone and Joint Infection Clinic, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia. (4)Expert of the Department for Analysis of Medical Information, National Ilizarov Medical Research Centre for Traumatology and Orthopaedics, 6 M. Ulianova street, Kurgan, Russia. INTRODUCTION: Treatment of infected nonunion of the distal juxta-articular tibia is a challenge due to a short distal fragment, deformity, thin soft-tissue envelope, and active infection. There is still no consensus on the approach that is able to maximally salvage the limb and ankle function. MATERIAL AND METHODS: Infected juxta-articular nonunion of the distal tibia was managed with two Ilizarov techniques, monofocal compression (MC) used in 12 patients and bifocal compression-distraction (BCD) in 6 patients. The choice of the technique depended on the size of the postresection defect, ≥3 cm or ≤3 cm, respectively. The tactics of functional approach were careful debridement, insertion of wires in the distal fragment so that they do not penetrate the ankle joint, stable fixation, and temporary bridging of the ankle and forefoot. MSCT was used along with regular radiography to assess the union and regeneration. Ankle functions were evaluated with AOFAS ankle-hindfoot score system. RESULTS: Bone consolidation, infection arrest and ankle function improvement were achieved in all patients. External fixation continued 221.7 ± 15.1 days for MC and 235 ± 25.8 days for BCD. Complications were wound divergence, wire-tract infection, premature consolidation of the fibula, and hypoplastic regeneration in one case. The mean functional AOFAS score after treatment was 90.7 ± 2.5 points in MC and 89.7 ± 1.3 in BCD patients. Residual limb discrepancy after MC ranged 0-4 cm. Bone shortening was compensated in BCD patients. CONCLUSION: Limb-salvage and functional approach to the treatment of infected nonunion of the juxta-articular distal tibia with the Ilizarov techniques achieves good outcomes. It provides bone infection arrest, consolidation, defect compensation and significantly improves the ankle joint function. © 2023 Delhi Orthopedic Association. All rights reserved. DOI: 10.1016/j.jcot.2023.102255 PMCID: PMC10561033