Bone transport and compression-distraction in the treatment of bone loss of the lower limbs. Injury, Int J Care Injures

Department of Orthopaedics and Traumatology, Policlinico G. B. Rossi, University of Verona, Italy.
Injury (Impact Factor: 2.14). 10/2010; 41(11):1191-5. DOI: 10.1016/j.injury.2010.09.030
Source: PubMed


A clinical series of 17 adult patients operated due to significant by bone loss of the long bones of the lower extremity (3 femurs and 11 tibias), is presented. Their management consisted of 6 bone transports (6 tibias) and 11 compression distraction procedures (3 femurs and 8 tibiae) using monolateral external fixators. Bone loss ranged from 3.9 cm to 14.7 cm. Mean healing time was 301 days with a mean healing index of 45.6 days for cm of lengthening achieved. The clinical and radiological results were excellent in 9, good in 6 and fair in 2 patients according to the utilised criteria of assessment. Consolidation was achieved in all but one patient who developed an aseptic stiff non-union. Two patients developed residual limb-length discrepancy less than 1.5 cm, three tibias ended up with less than 5° of valgus deviation. In two cases the half-pins were re-inserted due to early loosening. In two cases reoperation was needed for late bending of the callus after fixator removal. Three cases of bone transport and 1 case of compression distraction needed bone grafting at the docking site. Bone transport and compression-distraction are effective methods for treating bone loss in the lower extremity. It is suggested that the compression-distraction technique is preferable, since this is associated with a lower incidence of complications than bone transport procedures. The deciding factor, however, is the actual extent of the bone loss.

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    • "Simpson and Kenwright [41] report a fracture rate of 9.4 % in a series of 180 lengthening segments; O’Carrigan [42] reports an 8 % fracture rate in 650 patients with 986 lengthening segments, and Danziger [43] had refracture of the femur in 6 of 18 patients. Lavini [38] had axial deviation in 17.6 % in a series of 17 cases. In our previous study of 100 consecutive cases of bone transport using the Ilizarov method, we found 1 % refracture of the newly formed bone segment of the tibia, 17 % nonunion at the docking site in 10 femurs and 7 tibias, 10 % bone transport arrest due to the failure of distraction osteogenesis in 2 femurs and 8 tibias, and 4 % of cases had recurring infection [22]. "
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    ABSTRACT: A series of cases of reamed intramedullary nailings carried out after complications in regenerated bone and docking site had occurred in bone transport is presented here. Nine patients (femur = 5; tibia = 4) had treatment with resection after open fractures or infection and underwent bone transport. The mean length of regenerated bone was 9.5 cm (range 6-18 cm). After bone transport, the fixator remained in place for a mean period of 12.8 months (range 8-24 months). In six cases (femur 4; tibia 2), the thickness of the cortical wall of the regenerate column was insufficient, and in two of these, there was, in addition, nonunion of the docking site. In the two tibial cases, nailing was carried out shortly after the fixator had been removed and after refracture of the regenerated bone had occurred due to insufficient cortical thickness. In one femur, nailing was carried out for nonunion of the docking site. Follow-up involved clinical and X-ray checks. The mean follow-up was 3.9 years (range 2-6 years). In all cases, union and with complete corticalization of the regenerate column was observed at an average 6 months after nailing (range 4-11 months). Infection occurred in one tibia 4 months after nailing. The infection was treated with antibiotics, and the nail was subsequently removed. We conclude that nailing is a potential solution for regenerated bone and docking site problems but, if used after prolonged periods of external fixation, may necessitate antibiotic therapy for at least 10 days after the fixator has been removed.
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    ABSTRACT: Distraction osteogenesis is a valuable treatment method that allows limb lengthening or reconstruction of large bone defects. However, its major disadvantage is the long period required for the consolidation of a distraction callus. Osteogenic growth peptide (OGP) stimulates endochondral bone formation in fracture callus, but its capacity to promote regenerate ossification during distraction osteogenesis has not been evaluated. This study investigated whether intravenously administered OGP accelerated bone healing during distraction osteogenesis in 36 male New Zealand White rabbits, randomized into two groups. The treatment group received OGP (200 ng/kg body weight) in phosphate-buffered saline (PBS), intravenously, each day; the control group received PBS alone. A 15-mm lengthening of the right lower leg was performed using the method of Ilizarov. Evidence from biomechanical, histological and radiographic evaluations demonstrated that systemic OGP treatment promoted optimal new bone formation during distraction osteogenesis in this rabbit model.
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