Abstract
Introduction Infected non-unions of long bones with failure of internal fixation are difficult problems with a high amputation rate. Infection following intra-medullary nail fixation is associated with medullary osteomyelitis throughout the length of the bone. We present the results of management of these infected non-unions with intra-medullary lavage, antibiotic cement rod and Ilizarov bifocal transport.
Methods Pre-operative management included management of limb dystrophy and planning for soft tissue cover including angiography. The first stage consisted of removal of the infected hardware, intra-medullary lavage, excision of the necrotic bone with acute (or gradual) shortening, soft tissue coverage including muscle flaps, stabilisation with the Ilizarov device and insertion of a custom-made antibiotic cement rod. The second stage consisted of removal of the rod at six to eight weeks, with a proximal (or distal) lengthening osteotomy for bifocal transport. The docking site was grafted when necessary. Outcome measures used were union, time for treatment completion and the Baltimore/ASAMI bone and functional scores. Eleven consecutive infected non-unions with failure of internal fixation at three tertiary teaching hospitals were treated with staged salvage. All cases had been offered an amputation by their original treating teams. Nine cases had infected intramedullary nails, one had a plate and one an external fixator for an infected nail. There were 10 tibial and one femoral non-unions. Four cases required muscle flaps. The average length of bone resected was 4.8 cm (range 3 to 8).
Results The average time for completion of treatment was 9.8 months (range 5.5 to 11.3). All eleven cases went on to solid union, both at the resection site and the lengthening osteotomy site. The mean post-treatment radiographic leg-length-discrepancy was less than 0.5 cm. All cases had an excellent to good functional score and an excellent to good bone score.
Conclusions Antibiotic cement rod and Ilizarov bifocal transport offer a viable alternative to amputation in salvaging infected non-unions following internal fixation of long bones. Treatment is long and difficult, but a functional limb is salvaged as the end result.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
