Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol

2021 ◽  
Author(s):  
César Salcedo Cánovas ◽  
Javier Martínez Ros ◽  
Antonio Ondoño Navarro ◽  
José Molina González ◽  
Alicia Hernández Torres ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Lower Limb ◽  
Bone Defects ◽  
Two Stage

scholarly journals 33 Impact of Disruption of Tibio-Fibular Joints During Distraction Osteogenesis on Knee and Ankle Joint Function

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Zhou ◽  
M Girish ◽  
J A Lim ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Knee Osteoarthritis ◽  
Distraction Osteogenesis ◽  
Lower Limb ◽  
Distal Tibia ◽  
Bone Defects ◽  
Bone Transport ◽  
X Rays ◽  
Aofas Score ◽  
Post Surgery ◽  
Before And After

Abstract Aim The aim of this study is to investigate whether a disruption of proximal and/or distal tibio-fibular joint correlates to patient’s function and osteoarthritis. Method Retrospective analysis of 44 patients with lower limb bone defects treated by tibial corticotomy and distraction osteogenesis was conducted. Analysis of lower limb x-rays before surgery, immediately post-surgery and after frame removal permitted calculations of changes in tibial length and changes in fibula position relative to the tibia at the proximal and distal tibio-fibular joints. X-rays before and after treatment were also graded for osteoarthritis severity using Alhbäck's classification. Functional ability was scored using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Knee society score (KSS). Results 15 patients showed a decrease in the distance between fibular tip and distal tibia, 5 showed no change and 12 showed an increase at the end of the treatment. No statistical significant association was noted with KSS or AOFAS score (p > 0.05), however one patient with a large distance increase exhibited severe radiological exacerbation of knee osteoarthritis. The distal corticotomy group achieved significantly higher length of new bone (p < 0.001) and were more likely to have exacerbation of knee osteoarthritis (p < 0.05). Conversely, proximal corticotomy group were significantly more likely to show an exacerbation of ankle osteoarthritis (p < 0.05). Conclusions Attempts should be made not to disrupt the tibio-fibular joints during bone transport, but disruption does not necessarily correlate to poorer outcomes. Our results show that lengthening index reduces with larger bone defects, suggesting that radical debridement/resection may not negatively affect the healing index.

Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique

Injury ◽  
2021 ◽  
Author(s):  
Gonzalo Luengo-Alonso ◽  
Ismael Auñon Martin ◽  
Victor Rodriguez Vega ◽  
Aranzazu Capel Agundez ◽  
Pedro Caba Doussoux
Keyword(s):  
Lower Limb ◽  
Bone Defects ◽  
Long Term Results ◽  
Masquelet Technique

scholarly journals Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Jerzy Białecki ◽  
Maciej Kogut ◽  
Sławomir Chaberek ◽  
Paweł Bartosz ◽  
Marcin Obrębski ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Two Stage ◽  
Retrospective Assessment ◽  
Severe Bone Loss ◽  
Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

Distraction osteogenesis in the treatment of long bone defects of the lower limbs

2013 ◽  
Vol 95-B (12) ◽  
pp. 1673-1680 ◽  
Author(s):  
C. Papakostidis ◽  
M. Bhandari ◽  
P. V. Giannoudis
Keyword(s):  
Distraction Osteogenesis ◽  
Bone Defects ◽  
Lower Limbs ◽  
Long Bone

scholarly journals Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb

2009 ◽  
Vol 4 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Niels Willem Luitzen Schep ◽  
Esther M. M. van Lieshout ◽  
Peter Patka ◽  
Lucas M. M. Vogels
Keyword(s):  
Distraction Osteogenesis ◽  
Lower Limb ◽  
Post Traumatic

scholarly journals Risk factors associated with transport gap bending deformity after bone transport in the treatment of lower extremity bone defects caused by infection

2021 ◽  
Author(s):  
Kai Liu ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Chenchen Fan ◽  
Alimujiang Abulaiti ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixator ◽  
Lower Limb ◽  
Lower Extremities ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Infection ◽  
Limb Bone ◽  
Factors Associated ◽  
Independent Risk Factors

Abstract Background: The objective of this study was to observe the efficacy of bone transport using Orthofix external fixator in the treatment of lower limb bone defects caused by infection, and analyze the mechanism and risk factors of transport gap bending deformity (TGBD).Methods: From January 2008 to December 2019, 326 cases of infected bone defects of the lower extremities were treated by bone transport in our medical institution. The location and other relevant information of TGBD were collected, summarized, and analyzed. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. Results: A total of 326 patients have reconstructed the bone defects in the lower extremities successfully, with a mean size of 6.2 centimeters (3.4 - 9.1 cm). TGBD was observed in 42 patients (12.8%) after removing the external fixator, including 32 tibias and 10 femurs, after a mean follow-up of 28.6 months (22 – 47 months). Age>45years, BMI>25kg/m2, defect of the tibia, diabetes, osteoporosis, glucocorticoid intake, duration of bone infection>24months, EFT>9months, EFI>1.8months/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis. The independent risk factors associated with TGBD included age>45 years, BMI>25 kg/m2, defect of tibia, diabetes, osteoporosis. Conclusions: The bone transport using the Orthofix external fixator is a safe and practical method in the treatment of lower limb bone defects caused by infection. The incidence of TGBD was 12.8%, and the top five risk factors included defect of tibia, BMI>25kg/m2, duration of bone infection>24 months, age>45years, and diabetes. Age>45years, BMI>25kg/m2, defect of tibia, osteoporosis, diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.

scholarly journals Preliminary Results of the “Capasquelet” Technique for Managing Femoral Bone Defects—Combining a Masquelet Induced Membrane and Capanna Vascularized Fibula with an Allograft

2021 ◽  
Vol 11 (8) ◽  
pp. 774
Author(s):  
Alexis Combal ◽  
François Thuau ◽  
Alban Fouasson-Chailloux ◽  
Pierre-Paul Arrigoni ◽  
Marc Baud’huin ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Bone Defects ◽  
Reconstruction Technique ◽  
Femoral Bone ◽  
Two Stage ◽  
Induced Membrane ◽  
Preliminary Results ◽  
Vascularized Fibula ◽  
Functional Scores

We describe the preliminary results of a novel two-stage reconstruction technique for extended femoral bone defects using an allograft in accordance with the Capanna technique with an embedded vascularized fibula graft in an induced membrane according to the Masquelet technique. We performed what we refer to as “Capasquelet” surgery in femoral diaphyseal bone loss of at least 10 cm. Four patients were operated on using this technique: two tumors and two traumatic bone defects in a septic context with a minimum follow up of one year. Consolidation on both sides, when achieved, occurred at 5.5 months (4–7), with full weight-bearing at 11 weeks (8–12). The functional scores were satisfactory with an EQ5D of 63.3 (45–75). The time to bone union and early weight-bearing with this combined technique are promising compared to the literature. The osteoinductive role of the induced membrane could play a positive role in the evolution of the graft. Longer follow up and a larger cohort are needed to better assess the implications. Nonetheless, this two-stage technique appears to have ample promise, especially in a septic context or in adjuvant radiotherapy in an oncological context.

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