Comparison of acute compression distraction and segmental bone transport techniques in the treatment of tibia osteomyelitis
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1 Comparison of acute compression distraction and segmental bone transport techniques in the treatment of tibia osteomyelitis Eralp Levent 1, Sen Cengiz 1, Dikmen Goksel 1, Tomak Yılmaz 2, Gulsen Mahir 3, Balci Halil 1, Bas Ali 1, Kocaoglu Mehmet 4, Çakmak Mehmet 1 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 23 th Annual Scientific Meeting New York
2 All Authors We have no potential conflicts with this presentation. 8/9/2013 2
3 LONG BONE DEFECTS 8/9/2013 3
4 DEBRIDEMENT Bone segment loss Soft tissue loss Leg-length discrepancy Deformity 8/9/2013 4
5 TREATMENT TECHNIQUES Papineau technique Internal fixation Compression Plates Vascularized free tissue transfer Soft tissue Bone Combined Technique Biologic Adjuncts (BMP s)
6 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)
7 CIERNY & MADER CLASSIFICATION Health of the host Extent of dead tissue (bone + soft tissue etc.) 8/9/2013 7
8 PATIENTS & METHODS Multicentre Istanbul Medical Faculty/ Memorial Hospital/ Ortopedia Hospital/Medicana Hospital Retrospective Level
9 PATIENTS & METHODS The first group; Bone Segment Transport The second group; Acute shortening & lengthening group
10 PATIENTS & METHODS Group 1 (Bone Segment Transport) Group 2 (Acute Shortening and lengthening) Number The Mean Bone loss 6,9 cm 7,8 cm Mean age years years
11 Group 1 (Bone Segment Transport) Group 2 (Acute Shortening+ lengthening) Radical debridement + temporary external fixation+antibioticimpregnated cement Free Flep 5 1 Docking Site Grafting
12 CASE- BST 40y F, infected atrophic nonunion
13 CASE- BST Infected segment resection+antibiotic soaked spongel (collagene) +bone segment transport
14 CASE- BST Postop 16,5 month Postop 4,5 month 14
15 CASE- BST After treatment
16 CASE- AS&L 33 y M First session Debridement antibiotic impregnated K wire, temporary ex fix
17 CASE- AS&L Acute Shortening 3 cm Reconstruction
18 CASE- AS&L After lengthening 7 cm
19 CASE- AS&L Postop 16,5 month After Treatment
20 Ex. Fix. Group CASE- AS&L 25 Male Motorcycle accident 2 prev. ops. C-M IV B local 8/9/
21 CASE- AS&L 8/9/
22 STATISTICAL ANALYSIS Mann-Whitney U test was used for statistical analysis. EFİ EFT BHT Complication number per patient Grefting
23 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) ,35* *p<0,
24 EFI Bone Healing Time STATISTICAL ANALYSIS Group Group
25 COMPLICATIONS Problem Group 1 (Bone Segment Transport) Grade 2 pin tract infection 17 cases, Limited ROM of the ankle joint 4 case Group 2 (Acute Shortening) Delayed maturation regenerate site 10 cases Grade 2 pin infection 6 case Obstacle Bone grafting 16 cases Bone grafting 8 cases Sequela Two nonuion Varus deformity two case Valgus deformity two case 10⁰ procurvatum deformity one case
26 Complication number per patients COMPLICATIONS Group
27 BONE SEGMENT TRANSPORT Defects 7<cm Vascular problems Muscle insufficiency around foot/ankle Patients unable to adapt postoperative rehabilitation Healthy soft tissue envelope
28 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)
29 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
30 In Memoriam...
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