Comparison of acute compression distraction and segmental bone

Comparison of acute compression distraction and segmental bone

Comparison of acute compression distraction and
segmental bone transport techniques in the
treatment of tibia osteomyelitis
Eralp Levent1, Sen Cengiz1, Dikmen Goksel1, Tomak Yılmaz2, Gulsen Mahir3, Balci Halil1, Bas Ali1,
Kocaoglu Mehmet4, Çakmak Mehmet1
1, Istanbul Medical Faculty, Department of Orthopedics and Traumatology, Istanbul
2 Medicana Hospital, Department of Orthopedics and Traumatology, Samsun
3 Ortopedia Hospital, Department of Orthopedics and Traumatology, Adana
4 Memorial Hospital Sisli, Department of Orthopedics and Traumatology, Istanbul
Limb Lengthening and Reconstruction Society
23th Annual Scientific Meeting
New York
09.08.2013
1
All Authors
We have no potential conflicts
with this presentation.
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LONG BONE DEFECTS
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DEBRIDEMENT
 Bone segment loss
 Soft tissue loss
 Leg-length discrepancy
 Deformity
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TREATMENT TECHNIQUES
 Papineau technique
 Internal fixation
 Compression Plates
 Vascularized free tissue
transfer


Soft tissue
Bone
 Combined Technique
 Biologic Adjuncts (BMP’s)
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EX FIX TECHNIQUES
 Compression with circular fixator
 Acute shorthening and lenghtening (bifocal)
 Bone segment transport technique
 Bone segment transport over an intramedullary nail with
external fixator (combined technique)
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CIERNY & MADER
CLASSIFICATION
• Health of the host
• Extent of dead tissue (bone + soft tissue etc.)
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PATIENTS & METHODS
 Multicentre
 Istanbul Medical Faculty/ Memorial Hospital/ Ortopedia
Hospital/Medicana Hospital
 Retrospective
 Level 4
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PATIENTS & METHODS
 The first group; Bone Segment Transport
 The second group; Acute shortening & lengthening group
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PATIENTS & METHODS
Group 1
(Bone Segment Transport)
Group 2
(Acute Shortening and
lengthening)
Number
29
45
The Mean Bone loss
6,9 cm
7,8 cm
Mean age
37.64 years
34.82 years
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Group 1
(Bone Segment Transport)
Group 2
(Acute Shortening+
lengthening)
Radical debridement +
temporary external
fixation+antibioticimpregnated cement
18
10
Free Flep
5
1
Docking Site Grafting
16
8
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CASE- BST
40y F , infected atrophic nonunion
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CASE- BST
 Infected segment resection+antibiotic soaked
spongel (collagene) +bone segment transport
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CASE- BST
Postop
16,5
month
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Postop 4,5 month
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CASE- BST
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After treatment
15
CASE- AS&L
33 y M First session
Debridement antibiotic impregnated K wire,
temporary ex fix
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CASE- AS&L
Acute Shortening
3 cm
Reconstruction
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CASE- AS&L
After lengthening 7 cm
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CASE- AS&L
Postop 16,5 month
After
Treatment
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Ex. Fix. Group
CASE- AS&L
• 25 Male
• Motorcycle
accident
• 2 prev. ops.
• C-M IV B local
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CASE- AS&L
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STATISTICAL ANALYSIS
 Mann-Whitney U test was used for statistical analysis.
 EFİ
 EFT
 BHT
 Complication number per patient
 Grefting
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Results
Group 1
(Bone Segment Transport)
Group 2
(Acute Shortening+
lengthening)
Follow up (month)
55,6 (12-66)
39,9 (13-80)
EFI (day/cm)-mean
62,60
48,39*
Paley bone score
21 excellent, 4 good, 4 poor
35 excellent, 8 good, 2 fair
Bone Healing Index(BHI)
(month/cm)
1.75
1,35*
*p<0,05
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EFI
Bone Healing Time
STATISTICAL ANALYSIS
Group
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Group
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COMPLICATIONS
Group 1
(Bone Segment
Transport)
Problem
Group 2
(Acute Shortening)
Grade 2 pin tract infection Delayed maturation
17 cases,
regenerate site 10 cases
Limited ROM of the
ankle joint 4 case
Grade 2 pin infection 6
case
Obstacle
Bone grafting 16 cases
Bone grafting 8 cases
Sequela
Two nonuion
Valgus deformity two case
Varus deformity two case
10⁰ procurvatum
deformity one case
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Complication number per patients
COMPLICATIONS
Group
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BONE SEGMENT TRANSPORT

Defects 7<cm

Vascular problems

Muscle insufficiency around foot/ankle

Patients unable to adapt postoperative rehabilitation

Healthy soft tissue envelope
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ACUTE S & L
 Provide an acute (+ gradual) correction up to 7 cm with
attend to foot vasculary circulation
 Bone contact surface %50>
 Butterfly fragment or comminuted fracture
 Soft tissue defect <3 cms (Acute correction promotes
primary closure of the defect)
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CONCLUSION
 Bone segment transport and acute compression + lengthening technique can
be used safely for CM type 3-4 OM treatment.
 Patient selection is the key point.
 Soft tissue envelope around the tibia!!!
 There was no statistically significant differences for complications numbers
per patient between the groups.
 BST has a longer EFT that’s why more complications are expected.
 In appropriate cases, acute compression technique may provide higher
patients satisfaction because of shorter external fixator time, EFİ,BHİ
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In Memoriam...