Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Xun , ZHANG Wentao , YU Zirui , WANG Yufei , ZHANG Shihui ,  SONG Tao

Department of Bone Microsurgery, Honghui Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

SONG Tao, Email: fbbycx@163.com

Keywords：

Tibia; infected nonunion; bone transport; bone defect

DOI：

10.7507/1002-1892.201811024

Video：

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Objective To summarize the effectiveness of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion.Methods Between January 2010 and December 2014, 23 patients with infected tibial nonunion were treated with bone transport with unilateral external fixator combined with locked plate internal fixation. There were 19 males and 4 females with an average age of 37.8 years (range, 19-54 years). The mean length of the bone defect was 6.5 cm (range, 5.2-8.1 cm). The number of previous operations ranged from 2 to 4 times, with an average of 2.5 times. The time from injury to this treatment was 7-23 months, with an average of 11.8 months. The time of bone transport, time of the external fixation, fracture healing time, external fixation index, healing index, and complication were recorded; and the Association for the Study and Application of the Methods of Ilizarov (ASAMI) bone healing and function scores were used to evaluate the effectiveness.Results All patients were followed up 3-6 years with an average of 4.8 years. Wounds and bone defects healed in all patients. No complication such as infection recurrence, nonunion, re-fracture, malunion, iatrogenic nerve paralysis, or stiffness of knee and ankle joints occurred. Five patients had needle infections which were treated by local care and no deep infection occurred. The time of bone transport was 65-120 days (mean, 75.6 days); the time of the external fixation was 75-145 days (mean, 97.8 days); the fracture healing time was 4-17 months (mean, 8.7 months); the external fixation index was 18-28 days/cm (mean, 22.4 days/cm); and the healing index was 31-52 days/cm (mean, 40.2 days/cm). At last follow-up, according to ASAMI criteria, the result of bone healing was excellent in 15 cases and good in 8 cases, and the result of function was excellent in 18 cases and good in 5 cases, all with the excellent and good rate of 100%.Conclusion For infected tibial nonunion, bone transport with unilateral external fixator combined with locked plate internal fixation can reduce the time of external fixation and related complications, with a satisfactory effectiveness.

Citation： CHEN Xun, ZHANG Wentao, YU Zirui, WANG Yufei, ZHANG Shihui, SONG Tao. Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 328-331. doi: 10.7507/1002-1892.201811024 Copy

1.	Rohilla R, Wadhwani J, Devgan A, et al. Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis. Bone Joint J, 2016, 98-B(10): 1399-1405.
2.	Chaudhary MM. Infected nonunion of tibia. Indian J Orthop, 2017, 51(3): 256-268.
3.	Gupta S, Malhotra A, Mittal N, et al. The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate. Bone Joint J, 2018, 100-B(8): 1094-1099.
4.	傅德皓. Ilizarov技术治疗胫骨大段感染性骨缺损并发症分析. 创伤外科杂志, 2018, 20(7): 559-561.
5.	Emara KM, Ghafar KA, Al Kersh MA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop, 2011, 2(9): 85-92.
6.	Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res, 2008, 466(12): 2923-2932.
7.	Kim SJ, Mandar A, Song SH, et al. Pitfalls of lengthening over an intramedullary nail in tibia: a consecutive case series. Arch Orthop Trauma Surg, 2012, 132(2): 185-191.
8.	厉孟, 刘锐, 高杰, 等. Ilizarov技术修复创伤后桡骨远端畸形并骨缺损. 中国修复重建外科杂志, 2018, 32(10): 1275-1280.
9.	朱跃良, 徐永清, 秦泗河. Ilizarov器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(10): 1238-1240.
10.	Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J, 2013, 95-B(12): 1673-1680.
11.	Rozbruch SR, Pugsley JS, Fragomen AT, et al. Repair of tibial nonunions and bone defects with the Taylor Spatial Frame. J Orthop Trauma, 2008, 22(2): 88-95.
12.	黄雷, 赵刚, 王慎东, 等. 短缩-延长肢体治疗胫骨骨缺损合并软组织缺损. 中华创伤骨科杂志, 2007, 9(12): 1115-1119.
13.	Yin P, Ji Q, Li T, et al. A systematic review and meta-analysis of Ilizarov methods in the treatment of infected nonunion of tibia and femur. PLoS One, 2015, 10(11): e0141973.
14.	Cierny G 3rd, Zorn KE. Segmental tibial defects. Comparing conventional and Ilizarov methodologies. Clin Orthop Relat Res, 1994, (301): 118-123.
15.	Dagher F, Roukoz S. Compound tibial fractures with bone loss treated by the Ilizarov technique. J Bone Joint Surg (Br), 1991, 73(2): 316-321.
16.	Green SA, Jackson JM, Wall DM, et al. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res, 1992, (280): 136-142.
17.	Oh CW, Apivatthakakul T, Oh JK, et al. Bone transport with an external fixator and a locking plate for segmental tibial defects. Bone Joint J, 2013, 95-B(12): 1667-1672.

1. Rohilla R, Wadhwani J, Devgan A, et al. Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis. Bone Joint J, 2016, 98-B(10): 1399-1405.
2. Chaudhary MM. Infected nonunion of tibia. Indian J Orthop, 2017, 51(3): 256-268.
3. Gupta S, Malhotra A, Mittal N, et al. The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate. Bone Joint J, 2018, 100-B(8): 1094-1099.
4. 傅德皓. Ilizarov技术治疗胫骨大段感染性骨缺损并发症分析. 创伤外科杂志, 2018, 20(7): 559-561.
5. Emara KM, Ghafar KA, Al Kersh MA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop, 2011, 2(9): 85-92.
6. Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res, 2008, 466(12): 2923-2932.
7. Kim SJ, Mandar A, Song SH, et al. Pitfalls of lengthening over an intramedullary nail in tibia: a consecutive case series. Arch Orthop Trauma Surg, 2012, 132(2): 185-191.
8. 厉孟, 刘锐, 高杰, 等. Ilizarov技术修复创伤后桡骨远端畸形并骨缺损. 中国修复重建外科杂志, 2018, 32(10): 1275-1280.
9. 朱跃良, 徐永清, 秦泗河. Ilizarov器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(10): 1238-1240.
10. Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J, 2013, 95-B(12): 1673-1680.
11. Rozbruch SR, Pugsley JS, Fragomen AT, et al. Repair of tibial nonunions and bone defects with the Taylor Spatial Frame. J Orthop Trauma, 2008, 22(2): 88-95.
12. 黄雷, 赵刚, 王慎东, 等. 短缩-延长肢体治疗胫骨骨缺损合并软组织缺损. 中华创伤骨科杂志, 2007, 9(12): 1115-1119.
13. Yin P, Ji Q, Li T, et al. A systematic review and meta-analysis of Ilizarov methods in the treatment of infected nonunion of tibia and femur. PLoS One, 2015, 10(11): e0141973.
14. Cierny G 3rd, Zorn KE. Segmental tibial defects. Comparing conventional and Ilizarov methodologies. Clin Orthop Relat Res, 1994, (301): 118-123.
15. Dagher F, Roukoz S. Compound tibial fractures with bone loss treated by the Ilizarov technique. J Bone Joint Surg (Br), 1991, 73(2): 316-321.
16. Green SA, Jackson JM, Wall DM, et al. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res, 1992, (280): 136-142.
17. Oh CW, Apivatthakakul T, Oh JK, et al. Bone transport with an external fixator and a locking plate for segmental tibial defects. Bone Joint J, 2013, 95-B(12): 1667-1672.

Chinese Journal of Reparative and Reconstructive Surgery

Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion

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