Bone Transport Over the Intramedullary Nail for Defects of Long Bone

Intramedullary nailing is the method of choice for the treatment of most femoral shaft fractures. However, it is not always an easy procedure with predictable results as leg length discrepancy as well as rotational and angular malunion may occur. Lengthening over an intramedullary nail (IMN) has become very common as it allows early removal of the external fixator. This report presents a case of an open femoral shaft fracture initially treated with an IMN and subsequently complicated by a septic nonunion. Union was obtained by bifocal bone transport with a circular external fixator over the preexisting nail without exchange or removal of the previously inserted IMN. In conclusion, the presence of an IMN supports osteotomy and regenerates bone during bone healing, prevents fracture and/or deformation of the regenerated bone, and reduces the time needed for the external fixator.

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Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients

Patient Safety in Surgery ◽

10.1186/s13037-019-0215-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Carlos Augusto Finelli ◽

Fernando Baldy dos Reis ◽

Helio Alvachian Fernandes ◽

Adriana Dell’Aquila ◽

Rogério Carvalho ◽

...

Keyword(s):

Intramedullary Nail ◽

Controlled Trial ◽

Long Bone ◽

Cement Spacer ◽

Coagulase Negative Staphylococci ◽

Radiological Criteria ◽

Intramedullary Reaming ◽

Prospective Randomized Controlled Trial ◽

Retrograde Nail

Abstract Background Studies addressing the management of intramedullary infection are mainly retrospective and with a limited number of cases. Reaming can be performed using either conventional reaming or using the reamer/irrigator/aspirator (RIA) system. Until now there have been no comparative prospective studies between these two methods. We aimed to compare the efficacy of RIA with conventional reaming followed by insertion of antibiotic-loaded cement, for the treatment of intramedullary nail infection of long bones. We assessed the rate of remission between groups after two-year follow-up and identified microorganisms using tissue cultures and sonication of explanted intramedullary nail (IMN). Methods A noninferiority, randomized clinical trial was carried out between August 2013 and August 2015 involving 44 patients of whom a locked IMN implant of the femur and/or tibia was retrieved and who all met the clinical and radiological criteria for IMN-associated osteomyelitis. Patients were randomized into two groups: RIA alone versus conventional reaming followed by antibiotic-loaded cement insertion. Both groups also underwent six-weeks of antibiotic treatment according to the results of the antibiogram. Patients were evaluated after 1, 3, 6, 12 and 24 months for radiological and clinical follow-up. Results After 24 months, the rate of infection remission was similar between the two groups, 87% in the RIA group and 95.5% in the conventional reaming group (p = 0.60). Among four patients who had recurrence of infection, the time to reappearance of symptoms varied from 20 days to twenty-two months. Staphylococcus aureus and coagulase-negative Staphylococci were isolated in 23 (40.4%) and 13 (22.9%) patients, respectively. Interestingly, we identified 20% (9/45) of polymicrobial infection. Conclusion This study concludes that the RIA system alone, is noninferior to conventional reaming followed by antibiotic cement spacer in the treatment of IMN infection. However, RIA shows greater efficacy in the collection of infected medullary bone tissue, mainly in cases of infected retrograde nail of the femur. Trial registration ISRCTN82233198. Retroactively registered on July 29, 2019.

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Chronic long bone osteomyelitis

10.1093/med/9780199550647.003.011001 ◽

2011 ◽

Author(s):

Peter Calder

Keyword(s):

Soft Tissues ◽

Chronic Osteomyelitis ◽

Free Tissue Transfer ◽

Free Flaps ◽

Autologous Bone Graft ◽

Bone Transport ◽

Soft Tissue Defect ◽

Long Bone ◽

Space Management ◽

Secondary Intention

Pathological features of chronic osteomyelitis♦ Necrotic bone♦ Compromised soft tissues with reduction in vascularity♦ Ineffective host response♦ Sequestrum formation♦ New bone formation from viable periosteum and endosteum♦ Formation of involucrum:Treatment principles in chronic osteomyelitis♦ Surgical debridement – remove all devitalized necrotic tissue♦ Dead space management:• Soft tissue defect – avoid healing by secondary intention. Consider local and free flaps• Bone defects – small structural with autologous bone graft, consider Papineau ‘open bone grafting’ where free tissue transfer is not an option, distraction osteogenesis with bifocal and bone transport for large defects including fibula transfer♦ Bone stability – movement needs to be eliminated♦ Antibiotic therapy – based on culture and sensitivity, local administration with PMMA beads or collagen sponge, Lautenbach procedure in resistant cases.

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Antibiotic-Coated Interlocking Intramedullary Nail for the Treatment of Long-Bone Osteomyelitis

JBJS Reviews ◽

10.2106/jbjs.rvw.16.00095 ◽

2017 ◽

Vol 5 (7) ◽

pp. e5-e5 ◽

Cited By ~ 12

Author(s):

James Barger ◽

Austin T. Fragomen ◽

S. Robert Rozbruch

Keyword(s):

Intramedullary Nail ◽

Long Bone ◽

Interlocking Intramedullary Nail ◽

Long Bone Osteomyelitis

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Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-1008-x ◽

2012 ◽

Vol 23 (4) ◽

pp. 457-464 ◽

Cited By ~ 9

Author(s):

Jun Wan ◽

Lin Ling ◽

Xiang-sheng Zhang ◽

Zhi-hong Li

Keyword(s):

Retrospective Study ◽

External Fixator ◽

Intramedullary Nail ◽

Bone Transport ◽

Femoral Bone ◽

Monolateral External Fixator

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Tibial Bone Transport Over an Intramedullary Nail Using Cable and Pulleys

JBJS Essential Surgical Techniques ◽

10.2106/jbjs.st.17.00035 ◽

2018 ◽

Vol 8 (1) ◽

pp. e9 ◽

Cited By ~ 8

Author(s):

Mitchell Bernstein ◽

Austin Fragomen ◽

S. Robert Rozbruch

Keyword(s):

Intramedullary Nail ◽

Bone Transport ◽

Tibial Bone

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Combined use of the Ilizarov non-free bone plasty and Masquelet technique in patients with acquired bone defects and pseudarthrosis

Genij Ortopedii ◽

10.18019/1028-4427-2020-26-4-532-538 ◽

2020 ◽

Vol 26 (4) ◽

pp. 532-538

Author(s):

D.Yu. Borzunov ◽

◽

D.S. Mokhovikov ◽

S.N. Kolchin ◽

E.N. Gorbach ◽

...

Keyword(s):

Bone Grafting ◽

Soft Tissues ◽

Bone Defects ◽

Bone Transport ◽

Long Bone ◽

Cement Spacer ◽

Technical Problems ◽

Induced Membrane ◽

Masquelet Technique ◽

Membrane Technique

Introduction The Masquelet induced membrane technique is effective in the management of acquired heterogeneous long bone defects and pseudarthrosis. The combination of the Masquelet technology and Ilizarov non-free bone grafting seems promising and reduces the risks of recurrence at long-term in patients with congenital pseudarthrosis. Purpose Presentation of new technological solutions that allow combining the advantages of the Ilizarov bone transport and Masquelet bone grafting in patients with acquired bone defects. Materials and methods Retrospective assessment of the results of bone reconstruction in 10 patients who were treated by a combination of Ilizarov and Masquelet bone grafting technologies to repair long bone defects after failures of previous treatment. Fragments of the biomembrane formed around the cement spacer temporarily replacing the tibial gap after resection bone defect or pseudarthrosis were examined in all patients. The studies were carried out using a Reichard sledge microtome, an AxioScope stereomicroscope and an AxioCam ICc 5 digital camera, a JSM- 840 scanning electron microscope and an INCA-200 Energy X-ray electron probe microanalyzer. Results and discussion The combined Masquelet technique and Ilizarov non-free bone plasty provide the conditions that are favorable for reparative processes of the transported fragments. After removal of the spacer, there is a tunnel formed in the interfragmental gap, the walls of which are made of the induced membrane. Bone transport is carried out without technical problems through the compromised tissues which are debrided at the time of distraction initiation, outside the scars. At the same time, there are low risks of inflammation around the transosseous elements; there is no danger of cutting and perforation of soft tissues by transported fragments. Conclusions Complete organotypic rearrangement of the distraction regenerate with the use of Ilizarov non-free bone plasty and the Masquelet technique excludes the possibility of deformities or fractures at the level of newly formed bone areas. Active distraction histogenesis ensures the closure of soft tissue defects without additional reconstructive plastic interventions. The revealed dependence of the induced membrane blood supply on the method of treatment previously used might be a criterion for predicting the treatment outcome in patients with acquired bone defects and pseudarthrosis.

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