scholarly journals Pseudoartrosis séptica de tibia por pseudomona aeruginosa. Tratamiento mediante transporte óseo.

2020 ◽  
pp. 131-135
Author(s):  
E FERRANDO MESEGUER ◽  
FRANCISCO SEGURA LLOPIS ◽  
F L ALMEIDA HERRERO ◽  
ALBERTO TEJEDA GÓMEZ ◽  
DAMIAN MIFSUT MIEDES
Keyword(s):  
Antibiotic Therapy ◽  
Bone Grafting ◽  
Multidisciplinary Approach ◽  
Soft Tissues ◽  
Distal Tibia ◽  
Bone Transport ◽  
Docking Site ◽  
Non Union ◽  
Orthopedic Surgeons ◽  
Common Location

Septic non union has still been a challenge for orthopedic surgeons. Its resolution is complex and has hight morbility. It needs a multidisciplinary approach. Distal tibia is a common location due its poor vascularity and soft tissues. We present a patient with pseudoarthrosis of the tibia treated with resection and bone transport. Contact was achieved at the docking site at 5 months. Bone grafting and freshening of fracture ends was performed. At 12 months the frame was removed after complete consolidation. As the only complication, the patient suffered two episodes of cellulitis that were resolved with antibiotic therapy.

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

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.

scholarly journals Highly Cancellous Titanium Alloy (TiAl6V4) Surfaces on Three-Dimensionally Printed, Custom-Made Intercalary Tibia Prostheses: Promising Short- to Intermediate-Term Results

2021 ◽  
Vol 11 (5) ◽  
pp. 351
Author(s):  
Wiebke K. Guder ◽  
Jendrik Hardes ◽  
Markus Nottrott ◽  
Lars E. Podleska ◽  
Arne Streitbürger
Keyword(s):  
Titanium Alloy ◽  
Limb Salvage ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Case Series ◽  
Complication Rates ◽  
Non Union ◽  
Custom Made ◽  
3D Printed

Custom-made, three-dimensionally-printed (3D) bone prostheses gain increasing importance in the reconstruction of bone defects after musculoskeletal tumor resections. They may allow preservation of little remaining bone stock and ensure joint or limb salvage. However, we believe that by constructing anatomy-imitating implants with highly cancellous titanium alloy (TiAl6V4) surfaces using 3D printing technology, further benefits such as functional enhancement and reduction of complications may be achieved. We present a case series of four patients reconstructed using custom-made, 3D-printed intercalary monobloc tibia prostheses treated between 2016 and 2020. The mean patient age at operation was 30 years. Tumor resections were performed for Ewing sarcoma (n = 2), high-grade undifferentiated pleomorphic bone sarcoma (n = 1) and adamantinoma (n = 1). Mean resection length was 17.5 cm and mean operation time 147 min. All patients achieved full weight-bearing and limb salvage at a mean follow-up of 21.25 months. One patient developed a non-union at the proximal bone-implant interface. Alteration of implant design prevented non-union in later patients. Mean MSTS and TESS scores were 23.5 and 88. 3D-printed, custom-made intercalary tibia prostheses achieved joint and limb salvage in this case series despite high, published complication rates for biological and endoprosthetic reconstructions of the diaphyseal and distal tibia. Ingrowth of soft tissues into the highly cancellous implant surface structure reduces dead space, enhances function, and appears promising in reducing complication rates.

scholarly journals Quadriceps-splitting midline approach in the treatment of distal femur infected nonuinon with stiff knee and severely scarred soft tissues

2020 ◽  
Vol 6 (2) ◽  
pp. 276
Author(s):  
Jeremy Bliss ◽  
Dan Barnabas Inja ◽  
Manasseh Nithyananth ◽  
Vinoo Mathew Cherian
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Soft Tissues ◽  
Distal Femur ◽  
Bony Union ◽  
Infected Nonunion ◽  
Non Union ◽  
Knee Stiffness ◽  
Iliac Crest Bone Grafting ◽  
Stiff Knee

<p class="abstract"><strong>Background:</strong> Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.<strong></strong></p><p class="abstract"><strong>Results:</strong> 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant <em>in situ</em>. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.</p><p class="abstract"><strong>Conclusions:</strong> In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover.</p>

STRESS FRACTURE AT DOCKING SITE AFTER BONE TRANSPORT MANAGED WITH INTRAMEDULLARY INTERLOCKING NAIL AND ILIAC AUTOGRAFT - A RARE CASE REPORT

2021 ◽  
pp. 12-14
Author(s):  
Neetin P Mahajan ◽  
Tushar C Patil ◽  
Kevin A Jain ◽  
Ravi Dadhaniya
Keyword(s):  
Case Report ◽  
Functional Outcome ◽  
Distraction Osteogenesis ◽  
Rare Case ◽  
Soft Tissues ◽  
Bone Transport ◽  
Bony Union ◽  
Docking Site ◽  
Rare Case Report ◽  
Fracture Consolidation

INTRODUCTION : Distraction osteogenesis was introduced by Ilizarov and further developed by Cataneo et al. The concept of formation of new bone and soft tissues from distraction osteogenesis and freshening the sclerosed bone ends by corticotomy for stronger bony union and consolidation is applied here. Here we present a CASE REPORT : rare case of young adult operated by tibial bone transport using monolateral external xator, who presented to us after refracture near the docking site. We managed this patient with intramedullary reamed nailing and iliac crest autografting, showing good bony union and functional outcome at 3 months postoperatively. CONCLUSION : Thus from previous literature and our case ndings, we conclude that re-fractures and other complications of bone transport can be effectively managed by intramedullary reamed nailing leading to good bony union and fracture consolidation. The intramedullary nail provides rigid stability to both new bone regenerate due to callotasis and union at docking sit, signicantlydecreased rates of future refractures. This signicantly decreases patients morbidity and delivering satisfactory functional outcome.

A Case of Non-Union of Ulna Fracture Managed with Tibial Strut Cortico-Cancellous Bone Grafting in a Paediatric Patient

2017 ◽  
Vol 22 (03) ◽  
pp. 396-402
Author(s):  
Collin S.K. Looi ◽  
Roohi S.A. ◽  
Ranjit Singh Gill
Keyword(s):  
Paediatric Patient ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Bone Transport ◽  
Forearm Fractures ◽  
Cancellous Bone Grafting ◽  
Non Union ◽  
Fractures In Children ◽  
Fibular Grafting

Forearm fractures in children complicated with non-union are uncommon. Various methods have previously been reported to manage this condition. Well documented techniques would include iliac crest grafting, cancellous insert grafting, ulnar segment grafting, cortical tibial grafting, vascularized fibular grafting and bone transport by ring fixation. The authors present a case of a child with an atrophic non-union of the ulna who was successfully treated with a cortico-cancellous tibial strut bone graft.

scholarly journals Endoscopic approach for docking site bone grafting in Taylor Spatial Frame during bone transport

Injury Extra ◽  
2009 ◽  
Vol 40 (9) ◽  
pp. 175-177 ◽  
Author(s):  
Francesco Sala ◽  
Enzo Marinoni ◽  
Fabio Castelli ◽  
Dario Capitani ◽  
Giovanni Lovisetti ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Bone Transport ◽  
Endoscopic Approach ◽  
Taylor Spatial Frame ◽  
Docking Site ◽  
Spatial Frame

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

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