Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENG Xiuan ^1,2 , HUANG Jicheng ³ ,  LI Meng ² , YANG Qibing ^1,2 , WANG Kejing ^1,2 , GAO Zhenyang ^1,2 , WANG Qiyuan ² , LUO Xiangli ²

1. The First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou Gansu, 730099, P. R. China;
2. The Third Department of Orthopedics, Gansu Provincial Hospital, Lanzhou Gansu, 730099, P. R. China;
3. Department of Orthopedics, China National Nuclear 504th Hospital, Lanzhou Gansu, 730030, P. R. China;

Corresponding author：

LI Meng, Email: lilionli@126.com

Keywords：

Limited internal fixation; hinged external fixator; peri-elbow bone infection

DOI：

10.7507/1002-1892.202212060

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Objective To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. Methods The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. Results All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up (P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. Conclusion Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Citation： ZENG Xiuan, HUANG Jicheng, LI Meng, YANG Qibing, WANG Kejing, GAO Zhenyang, WANG Qiyuan, LUO Xiangli. Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 694-699. doi: 10.7507/1002-1892.202212060 Copy

1.	Lima AL, Oliveira PR, Carvalho VC, et al. Recommendations for the treatment of osteomyelitis. Braz J Infect Dis, 2014, 18(5): 526-534.
2.	周武, 夏天, 刘梦非, 等. Ⅰ期清创联合抗生素骨水泥珠链填塞治疗骨折后慢性感染. 中华创伤杂志, 2018, 34(11): 1001-1006.
3.	傅景曙, 谢肇. 骨髓炎清创技术的研究进展. 中华创伤杂志, 2015, 31(7): 667-669.
4.	吴宏日, 贾硕, 傅景曙, 等. Enbloc切除结合膜诱导技术分期治疗长骨Cierny-MaderⅣ型创伤后骨感染. 中华创伤杂志, 2017, 33(2): 147-152.
5.	Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
6.	傅景曙, 喻胜鹏, 汪小华, 等. Masquelet技术治疗创伤后长骨骨髓炎的研究进展. 中华创伤骨科杂志, 2017, 19(2): 176-179.
7.	Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
8.	王依林, 韩娜, 崔浩然, 等. 肘关节术后感染性骨缺损Ⅱ期重建修复一例. 中华创伤杂志, 2018, 34(6): 573-576.
9.	El-Alfy BS, Maaty M, Niazy T. Reconstruction of infected nonunion of the distal humerus by Ilizarov external fixator. Injury, 2021, 52(6): 1418-1422.
10.	郑小龙, 杨明宇, 穆米多, 等. 肘关节松解联合铰链式外固定架治疗异位骨化所致肘关节屈伸功能障碍的中期疗效. 中国修复重建外科杂志, 2019, 33(10): 1299-1304.
11.	Feranec M, Hart R, Kozák T, et al. Hinged elbow external fixation for severe elbow stiffness. Acta Chir Orthop Traumatol Cech, 2019, 86(2): 136-140.
12.	He SK, Zhao SC, Guo JH, et al. Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24-month follow-up. ANZ J Surg, 2019, 89(3): 196-200.
13.	谢肇. 四肢长骨创伤后骨髓炎诊断与治疗的难点及挑战. 中华创伤杂志, 2015, 31(4): 289-293.
14.	王海, 黄游, 何晓青, 等. 感染性骨不连的治疗现状. 中国矫形外科杂志, 2017, 25(5): 438-441.
15.	陆维举, 钱宏波, 李斌, 等. 清创后Ⅰ期改良开放式松质骨移植治疗慢性骨髓炎. 中华创伤杂志, 2004, 20(5): 288-290.
16.	陆维举, 李斌, 曾晓峰, 等. 清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效. 中华创伤杂志, 2009, 25(12): 1090-1092.
17.	蒋协远, 张力丹, 刘兴华, 等. 可活动的铰链外固定架在肘部创伤治疗中的应用. 中华外科杂志, 2004, 42(12): 737-740.
18.	傅景曙, 汪小华, 王舒琳, 等. 膜诱导技术治疗成人胫骨平台骨折术后感染的临床疗效. 中华创伤杂志, 2020, 36(4): 335-340.
19.	Shen J, Sun D, Fu J, et al. Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures. Bone Joint Res, 2021, 10(7): 380-387.
20.	Yu X, Wu H, Li J, et al. Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects. Int Orthop, 2017, 41(9): 1851-1857.
21.	Castelli A, D’amico S, Combi A, et al. Hinged external fixation for Regan-Morrey type Ⅰ and Ⅱ fractures and fracture-dislocations. J Orthop Traumatol, 2016, 17(2): 175-179.
22.	厉孟, 蓝旭, 甄平, 等. 深筋膜下非接触钢板治疗隐匿感染性股骨再骨折. 中国修复重建外科杂志, 2018, 32(1): 25-30.

1. Lima AL, Oliveira PR, Carvalho VC, et al. Recommendations for the treatment of osteomyelitis. Braz J Infect Dis, 2014, 18(5): 526-534.
2. 周武, 夏天, 刘梦非, 等. Ⅰ期清创联合抗生素骨水泥珠链填塞治疗骨折后慢性感染. 中华创伤杂志, 2018, 34(11): 1001-1006.
3. 傅景曙, 谢肇. 骨髓炎清创技术的研究进展. 中华创伤杂志, 2015, 31(7): 667-669.
4. 吴宏日, 贾硕, 傅景曙, 等. Enbloc切除结合膜诱导技术分期治疗长骨Cierny-MaderⅣ型创伤后骨感染. 中华创伤杂志, 2017, 33(2): 147-152.
5. Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
6. 傅景曙, 喻胜鹏, 汪小华, 等. Masquelet技术治疗创伤后长骨骨髓炎的研究进展. 中华创伤骨科杂志, 2017, 19(2): 176-179.
7. Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
8. 王依林, 韩娜, 崔浩然, 等. 肘关节术后感染性骨缺损Ⅱ期重建修复一例. 中华创伤杂志, 2018, 34(6): 573-576.
9. El-Alfy BS, Maaty M, Niazy T. Reconstruction of infected nonunion of the distal humerus by Ilizarov external fixator. Injury, 2021, 52(6): 1418-1422.
10. 郑小龙, 杨明宇, 穆米多, 等. 肘关节松解联合铰链式外固定架治疗异位骨化所致肘关节屈伸功能障碍的中期疗效. 中国修复重建外科杂志, 2019, 33(10): 1299-1304.
11. Feranec M, Hart R, Kozák T, et al. Hinged elbow external fixation for severe elbow stiffness. Acta Chir Orthop Traumatol Cech, 2019, 86(2): 136-140.
12. He SK, Zhao SC, Guo JH, et al. Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24-month follow-up. ANZ J Surg, 2019, 89(3): 196-200.
13. 谢肇. 四肢长骨创伤后骨髓炎诊断与治疗的难点及挑战. 中华创伤杂志, 2015, 31(4): 289-293.
14. 王海, 黄游, 何晓青, 等. 感染性骨不连的治疗现状. 中国矫形外科杂志, 2017, 25(5): 438-441.
15. 陆维举, 钱宏波, 李斌, 等. 清创后Ⅰ期改良开放式松质骨移植治疗慢性骨髓炎. 中华创伤杂志, 2004, 20(5): 288-290.
16. 陆维举, 李斌, 曾晓峰, 等. 清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效. 中华创伤杂志, 2009, 25(12): 1090-1092.
17. 蒋协远, 张力丹, 刘兴华, 等. 可活动的铰链外固定架在肘部创伤治疗中的应用. 中华外科杂志, 2004, 42(12): 737-740.
18. 傅景曙, 汪小华, 王舒琳, 等. 膜诱导技术治疗成人胫骨平台骨折术后感染的临床疗效. 中华创伤杂志, 2020, 36(4): 335-340.
19. Shen J, Sun D, Fu J, et al. Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures. Bone Joint Res, 2021, 10(7): 380-387.
20. Yu X, Wu H, Li J, et al. Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects. Int Orthop, 2017, 41(9): 1851-1857.
21. Castelli A, D’amico S, Combi A, et al. Hinged external fixation for Regan-Morrey type Ⅰ and Ⅱ fractures and fracture-dislocations. J Orthop Traumatol, 2016, 17(2): 175-179.
22. 厉孟, 蓝旭, 甄平, 等. 深筋膜下非接触钢板治疗隐匿感染性股骨再骨折. 中国修复重建外科杂志, 2018, 32(1): 25-30.

Chinese Journal of Reparative and Reconstructive Surgery

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection

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