Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects

Kevin Tetsworth, Dror Paley, Cengiz Sen, Matthew Jaffe, Dean C. Maar, Vaida Glatt, Erik Hohmann, John E. Herzenberg

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Introduction This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length. Methods In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates. Results The mean size of the bone defect was 7 cm in Group A, and 5.8 cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P = 0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P = 0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P = 0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P = 0.28). Conclusions While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures. Level of evidence: Level III; Retrospective comparative study

Original languageEnglish (US)
Pages (from-to)2276-2284
Number of pages9
JournalInjury
Volume48
Issue number10
DOIs
StatePublished - Oct 2017

Keywords

  • Acute shortening
  • Bone lengthening
  • Bone transport
  • Distraction osteogenesis
  • External fixation
  • Ilizarov method
  • Infected non-union
  • Limb salvage
  • Osteomyelitis
  • Segmental defects

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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