Two-Stage Reconstruction of Infected Nonunion of Long Bones using Antibiotics-Impregnated Cement Beads

Background: Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.Methods: We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.Results: 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.Conclusions: The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities.

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Two-stage treatment with sliding fibular flap technique for chronic infected nonunion of the tibia

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2020.07.004 ◽

2020 ◽

Vol 23 (5) ◽

pp. 302-306

Author(s):

Rana Kapukaya ◽

Osman Ciloglu

Keyword(s):

Two Stage ◽

Infected Nonunion ◽

Flap Technique ◽

Fibular Flap

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Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211002701 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110027

Author(s):

Jiang Xie ◽

Guobin Zhao ◽

Tayierjiang Yasheng ◽

Hongtao Chen ◽

Nuermaimaiti Amuti ◽

...

Keyword(s):

Bone Healing ◽

Functional Assessment ◽

Bone Transport ◽

Functional Evaluation ◽

Long Bones ◽

Trauma Centers ◽

Infected Nonunion ◽

Bone Nonunion ◽

Study Population ◽

Ilizarov Bone Transport

Objective To examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones. Methods Patients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley’s criteria for bone healing and functional assessment. Results In total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11–61 years). The patients were followed up for at least 24 months. According to Paley’s criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%). Conclusion Infected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.

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An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

Journal of Orthopedics and Joint Surgery ◽

10.5005/jp-journals-10079-1049 ◽

2021 ◽

Vol 3 (2) ◽

pp. 76-79

Author(s):

Prabhat Agrawal ◽

N Rajkumar ◽

Murali Mothilal ◽

SV Sunny Deol ◽

V Arul Jothi

Keyword(s):

Long Bones ◽

Interventional Study ◽

Infected Nonunion ◽

Antibiotic Cement

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Two-stage reconstruction of infected Charcot foot using internal fixation

The Bone & Joint Journal ◽

10.1302/0301-620x.103b10.bjj-2021-0339.r2 ◽

2021 ◽

Vol 103-B (10) ◽

pp. 1611-1618

Author(s):

Venu Kavarthapu ◽

Basil Budair

Keyword(s):

Internal Fixation ◽

Limb Salvage ◽

Care Plan ◽

Surgical Reconstruction ◽

Charcot Foot ◽

Foot Deformity ◽

Two Stage ◽

Infected Nonunion ◽

Hardware Failure

Aims In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. Methods We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up. Results We identified 23 feet in 22 patients with a mean age of 56.7 years (33 to 70). The mean postoperative follow-up period was 44.7 months (14 to 99). Limb salvage was achieved in all patients. At one-year follow-up, all ulcers have healed and independent full weightbearing mobilization was achieved in all but one patient. Seven patients developed new mechanical skin breakdown; all went on to heal following further interventions. Fusion of the hindfoot was achieved in 15 of 18 feet (83.3%). Midfoot fusion was achieved in nine of 15 patients (60%) and six had stable and painless fibrous nonunion. Hardware failure occurred in five feet, all with broken dorsomedial locking plate. Six patients required further surgery, two underwent revision surgery for infected nonunion, two for removal of metalwork and exostectomy, and two for dynamization of the hindfoot nail. Conclusion Two-stage reconstruction of the infected and deformed Charcot foot using internal fixation and following the principle of ‘long-segment, rigid and durable internal fixation, with optimal bone opposition and local antibiotic elusion’ is a good form of treatment provided a multidisciplinary care plan is delivered. Cite this article: Bone Joint J 2021;103-B(10):1611–1618.

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