scholarly journals Analysis of bone transport for ankle arthrodesis as a limb salvage procedure for the treatment of septic pilon fracture nonunion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thomas Rosteius ◽  
Sebastian Lotzien ◽  
Matthias Königshausen ◽  
Valentin Rausch ◽  
Charlotte Cibura ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Ankle Joint ◽  
Functional Results ◽  
Ankle Arthrodesis ◽  
Bone Transport ◽  
Functional Score ◽  
Salvage Procedure ◽  
Pilon Fracture ◽  
Additional Surgery

AbstractSeptic nonunion of the pilon region with ankle joint infection is challenging for orthopedic surgeons to treat and is associated with a high risk of limb loss. Therefore, the aim of this study was to evaluate the effectiveness of bone transport for ankle arthrodesis in salvaging the limp after septic ankle destruction of the pilon region. We conducted a single-center, retrospective study including 21 patients treated for septic pilon nonunion with accompanying septic ankle destruction via Ilizarov bone transport between 2004 and 2018. In all cases, the complete excision of the nonunion and the resection of the ankle joint were carried out, followed by treating the bone and joint defect with a bone transport into the ankle arthrodesis. In 12/21 patients an additional flap transfer was required due to an accompanying soft tissue lesion. The overall healing and failure rate, final alignment and complications were recorded by the patients’ medical files. The bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and a modified American Orthopedic Foot and Ankle Society (AOFAS) scale. After a mean follow-up of 30.9 ± 15.7 months (range 12–63 months), complete bone and soft tissue healing occurred in 18/21 patients (85.7%). The patients had excellent (5), good (7), fair (4), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 6 patients had excellent, 7 good, and 6 fair results. The modified AOFAS score reached 60.6 ± 18 points (range, 29–86). In total, 33 minor complications and 28 major complications occurred during the study period. In 2 cases, a proximal lower leg amputation was performed due to a persistent infection and free flap necrosis with a large soft tissue defect, whereas in one case, persistent nonunion on the docking side was treated with a carbon orthosis because the patient refused to undergo an additional surgery. Bone transport for ankle arthrodesis offers the possibility of limb salvage after septic ankle destruction of the pilon region, with acceptable bony and functional results. However, a high number of complications and surgical revisions are associated with the treatment of this severe complication after pilon fracture.

scholarly journals ENDOPROSTHESIS-RELATED COMPLICATIONS AFTER LIMB-SALVAGE OPERATION OF MALIGNANT BONE TUMORS AROUND THE KNEE

2004 ◽  
Vol 16 (03) ◽  
pp. 133-142 ◽  
Author(s):  
RONG-SEN YANG
Keyword(s):  
Soft Tissue ◽  
Aseptic Loosening ◽  
Limb Salvage ◽  
Activity Level ◽  
Salvage Procedure ◽  
Leg Length ◽  
Salvage Operation ◽  
Limb Salvage Procedure ◽  
Custom Made ◽  
The Common

Endoprosthetic reconstruction using a custom-made metallic megaendoprosthesis is one of the common modalities for the limb salvage operation. The new promising advance of material science, design and fabrication of the endoprosthesis enable an immediate rehabilitation program and provide a durable and functional limb. Thus a successful limb reconstruction is possible in the well-selected patients. In addition to the endoprosthesis-related increased stress, a limited soft tissue support and constraint after limb salvage procedure usually results in an increased incidence of complications, especially in the long term survivors. Some patients may even need revision of the endoprosthesis and, at times, amputation. The complications after oncological endoprosthectic reconstructions usually occur more frequent than the conventional primary total joint arthroplasty. Considering the characteristics of the surgical procedure and the high demands on the implants, such a relatively high frequency of complications is not unexpected. The common complications include wound necrosis, aseptic loosening, fatigue fracture, local osteolysis, joint contracture, dislodgement/dislocation, nerve or vascular injury, rotational deformity, leg length discrepancy, infection, periprosthectic fracture, etc. Some complications are encountered with other modality of limb salvage procedure, whereas the other endoprosthesis-related complications are endoprosthetic-unique and not uncommon. The major causes of such a relatively high endoprosthesis-related complications include (1) extensive excision of soft tissue, leading to change of biomechanical ergonomics, little soft tissue constraints or support for a long replacement segments, and decreased local defense to infection, (2) increased stress on the implants due to higher activity level in the youthful active individuals, relatively narrower medullary canals with less cancellous bone for fixation, (3) special needs for the stability resulting an increased mechanical constraints placed directly within the endoprosthesis, thus raising the local stress transferred to the prosthesis, and to the prosthesis-bone interface, (4) poor immunological, hematological, or nutritional status resulting from chronic oncologic diseases or chemotherapy. It in turn accelerates the wear processes of the components, induces the wear particulate disease and local osteolysis, as well as to cause the aseptic loosening eventually. Early detection and early correction of minor complications has an important role of preventing the major complications, thus reduces the necessity of reoperation, and at times, amputation. We will review these complications in this article.

scholarly journals Demography and Short Term Functional Outcome of Soft Tissue Sarcoma Treated with Limb Salvage Surgery

2020 ◽  
Vol 16 (4) ◽  
pp. 238-245
Author(s):  
Suresh Pandey
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Negative Correlation ◽  
Salvage Surgery ◽  
Demographic Data ◽  
Functional Score ◽  
Limb Salvage Surgery ◽  
Positive Correlation

Background: Limb salvage surgery with or without radiotherapy and/or chemotherapy is the mainstay of treatment of Soft Tissue Sarcoma (STS). Though, many studies are found regarding the demographics and result of such malignancy from other parts of the world, such data is not available from our country. This study aimed to analyze the demographic data and functional outcome of STS treated with limb salvage surgery. Methods: It is a retrospective review of 16 cases of soft tissue sarcoma of extremities and trunk managed with limb salvage surgery followed by adjuvant radiotherapy and/or chemotherapy in indicated cases from 2012 to 2017. Demographic data and functional score after 2 years of surgery were analysed and presented. Results: There were 14 male and 2 female cases of STS with mean age of 32.88 years. The most common STS was liposarcoma (37.5%) followed by rhabdomyosarcoma (25%) and synovial sarcoma (18.8%). Extremity and lower limb were the most common sites. Mean MSTS functional score at the last follow up was 24.56 (81.83%) with range from 19-29 (63.33%-96.66%). There were good to excellent results in 13 cases (81.25%) and moderate result in 3 cases (18.75%) according to MSTS functional score. There was positive correlation of MSTS with age, radiotherapy, chemotherapy and negative correlation with grade of tumor. Conclusions: This study showed good to excellent functional results in 81.25% of cases as per Musculoskeletal Tumor Society Score (MSTS) with positive correlation with radiotherapy, chemotherapy, age and negative correlation with grade of tumor.

scholarly journals Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

2021 ◽  
Author(s):  
Pablo S. Corona ◽  
Carla Carbonell-Rosell ◽  
Matías Vicente ◽  
Jordi Serracanta ◽  
Kevin Tetsworth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Local Flap ◽  
Tissue Loss ◽  
Functional Score ◽  
Limb Salvage Rate ◽  
Soft Tissue Loss ◽  
Infection Eradication ◽  
Salvage Rate

Abstract Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

scholarly journals Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Nottrott ◽  
Arne Streitbürger ◽  
Georg Gosheger ◽  
Wiebke Guder ◽  
Gregor Hauschild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Rare Condition ◽  
Functional Results ◽  
Extensor Mechanism ◽  
Complication Rates ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.

scholarly journals Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report

2021 ◽  
Vol 18 (23) ◽  
pp. 12473
Author(s):  
Yong-Cheol Hong ◽  
Ki-Jin Jung ◽  
Hee-Jun Chang ◽  
Eui-Dong Yeo ◽  
Hong-Seop Lee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Limb Salvage ◽  
Ankle Joint ◽  
Daily Life ◽  
Emission Computed Tomography ◽  
Ankle Arthritis ◽  
Joint Deformity ◽  
The Right

Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length.

Treatment of AO/OTA Type C Pilon Fractures Through the Anterolateral Approach Combined With the Medial MIPO Technique

2018 ◽  
Vol 39 (4) ◽  
pp. 426-432 ◽  
Author(s):  
Gi Beom Kim ◽  
Oog-Jin Shon ◽  
Chul Hyun Park
Keyword(s):  
Ankle Joint ◽  
Case Series ◽  
Anterolateral Approach ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Pilon Fracture ◽  
Fibular Fracture ◽  
Additional Surgery ◽  
Type C ◽  
Pilon Fractures

Background: The purpose of this study was to evaluate the clinical and radiographic results of the treatment of AO/OTA type C pilon fracture via the anterolateral approach using a low-profile plate combined with medial minimally invasive plate osteosynthesis (MIPO). Methods: We retrospectively reviewed 28 ankles with AO/OTA type C pilon fractures that were treated using the anterolateral approach combined with medial MIPO. Mean age was 46 years (range, 19 to 75), and the mean follow-up period was 25 months (range, 14 to 50). Clinical results were assessed using the visual analogue scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Range of motion (ROM) of the ankle joint was measured, and postoperative complications were investigated via chart review. Results: The VAS and AOFAS Ankle-Hindfoot Scale were 2 and 89, respectively, at the last follow-up. Ankle ROM at the last follow-up was 13 degrees (range, 5 to 20) in dorsiflexion and 38 degrees (range, 35 to 40) in plantarflexion. All the fractures united without additional surgery. One patient (3.6%) had a deep infection at the fibular fracture site, and 1 patient (3.6%) had partial skin necrosis. Conclusion: This combined technique for AO/OTA type C pilon fracture resulted in good ROM of the ankle joint with reasonable function with a fairly low wound complication rate. However, further research on defined indications with a comparison group from multiple centers is necessary to determine if this technique is better than alternative surgical approaches. Level of Evidence: Level IV, case series.

scholarly journals Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110176
Author(s):  
Runguang Li ◽  
Canjun Zeng ◽  
Song Yuan ◽  
Yirong Chen ◽  
Shanwen Zhao ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Clinical Efficacy ◽  
Free Flap ◽  
Bone Transport ◽  
Fixation Index ◽  
Functional Score ◽  
Soft Tissue Defects ◽  
Ilizarov Bone Transport ◽  
Tissue Defects

Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.

scholarly journals Limb Salvage Procedure Using Affected Bone and Huckstep Intramedullary Rod for Invasive Soft Tissue Sarcoma of the Femur.

1998 ◽  
Vol 47 (2) ◽  
pp. 559-563
Author(s):  
Eiichiro Aso ◽  
Katsuki Taguchi ◽  
Keiji Mihara ◽  
Takashi Hashiguchi ◽  
Koichi Adachi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Limb Salvage ◽  
Salvage Procedure ◽  
Limb Salvage Procedure ◽  
Intramedullary Rod

scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2021 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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