Comparison of two defect reconstruction techniques following osteomyelitic bone segment debridement of the femur

Transcription

1 Comparison of two defect reconstruction techniques following osteomyelitic bone segment debridement of the femur Balci Halil 1,, Eralp Levent 1,, Sen Cengiz 1,, Tomak Yılmaz 2,Gülsen Mahir 3, Celiktas Mustafa 3, Dikmen Goksel 1, Bas Ali 1, Kocaoglu Mehmet 4,, Kapıcıoglu Mehmet 1 Cakmak 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 The Femur Cierny Mader Type 4 Osteomyelitis Need debridment with segmental resection that results in long bone defects Reconstruction of the defects depends both on the surgeon preference and local anatomic characteristics

4 Problems Bone segment loss Soft tissue loss Leg-length discrepancy Deformity

5 ACUTE COMPRESSION AND DISTRACTION (ACD) SEGMENT TRANSPORT (ST)

6 PATIENTS & METHODS 48 femur osteomyelitis Multicenter study conducted by Turkish LLRS İstanbul Medical Faculty Memorial Hospital Sisli Medicana Hospital Ortopedia Hospital Adana Retrospective Level 4

7 PATIENTS & METHODS SEGMENT TRANSPORT ACUTE COMPRESSION &DISTRACTION Patient Male / female 6/4 36/2 Age Combined techniques and spatial type external fixators are not included

8 PATIENTS & METHODS SEGMENT TRANSPORT ACUTE COMPRESSION &DISTRACTION Circular EX FIX 4 13 Monolateral (LRS) EX FIX 6 25

9 H.S 32 Y. M. Segment transport

10 H.S.

11 H.S.

12 H.S.

13 SEGMENT TRANSPORT ACUTE COMPRESSION & DISTRACTION Resection 8,2 7,5 Preop defect + shortening 4 2,5 Mean ESR Mean CRP No statistical difference in ESR and resection amount CRP value was significantly higher in acut COMPRESSION AND DISTRACTION group P<0,05 Preoperative shortening + defect was higher in segment transport group but not statistically significant (p>0,05)

14 M.C.48.Y..M. ACUTE COMPRESSıON AND DıSTRACTıON

15 M.C

16 M.C

17 Complications SEGMENT TRANSPORT ACUTE COMPRESSION & DISTRACTION PROBLEM OBSTACLE 6 15 SEQUELA 5 12 COMPLICATION /PERSON 2,1 1,3 there is a strong trend to words increased complication rate in the segment transport group (p=0,025 Mann-Whitney U test)

18 Complications SEGMENT TRANSPORT: 2 NON UNİON 4 DELAYED UNİON 3 SHORTENİNG MORE THAN 2 CM 5 DECREASE KNEE ROM 1 REFRACTURE 1 DEFORMITY ACUT COMPRESSİON DİSTRACTİON: 13 DECREASE KNEE ROM 9 DELAYED UNİON 2 SHANZ CUT OFF 1 COLLUM FEMORIS FRACTURE 2 SHORTENING MORE THAN 3 CM

19 Most of the difference in complication for the segmental transport cases Docking side problems Two stage surgery increase the period of the treatment.

20 Results The patient numbers in the two study groups do not allow a sound comparison. Anyway the performed analysis display quite significant conclusion point The treatment period and consolidation time was longer in segment transport group. (p>0,05)

21 PALEY FUNCTIONAL SCORE SEGMENT TRANSPORT ACUTE COMPRESSION, DISTRACTION EXCELLENT / GOOD 4 40% 17 44% FAİR 4 40% 17 44% POOR 2 20% 4 11% There is no significant differance (p>0,05)

22 PALEY BONE SCORE SEGMENT TRANSPORT ACUTE COMPRESSION DISTRACTION Excellent / good 3 30% 22 57% Fair 5 50% 11 28% poor 2 20% 5 15% Percent of excellent and good Bone score in ACD patients is higher than ST patients but not statistically significant (P>0,05)

23 S.K. 41 Y.F.

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26 Take Home Message Necrotic and infected tissues debridment is the main stay of the chronic osteomyelitis treatment The infection its self and the debridment of the surgeon cause big amount of bone loss External fixation techniques provide excellent solutions to these problems ST and ACD are two techniques Althougth there is no significant differences between two groups, the trend displays a lower EFI and concludingly lower complication rate in the ACD group

27 In Memoriam...