Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Tetsworth, Kevin; Paley, Dror; Sen, Cengiz; Jaffe, Matthew; Maar, Dean C.; Glatt, Vaida; Hohmann, Erik; Herzenberg, John E.
• Is Part Of: Injury. Volume 48:Issue 10(2017)
• Page Start: 2276
• Page End: 2284
• Publication Date: 2017-10
• Subjects: Infected non-union -- Osteomyelitis -- Segmental defects -- Acute shortening -- Bone transport -- Bone lengthening -- Ilizarov method -- Distraction osteogenesis -- External fixation -- Limb salvage; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2017.07.018
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Introduction: This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length. Methods: In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm 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 7 cm in Group A, and 5.8 cm 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