EXPANDABLE INTRAMEDULLARY NAILING SYSTEM IN THE TREATMENTOF INFECTED NON UNIONS OF THE LOWER LIMB

Abstract

Introduction: Treatment of infected non union of the lower limb has many possibilities. A new one, the Expandable Nailing System (ENS), already employed in traumatology, is presented here.

Materials and Methods: Between June 2001 and Dec.2003, 119 Patients with an infected non union of the long bones of the lower limbs (98 tibias, 21 femurs) were treated in our osteomyelitis centre. Most of the cases were men (87%), mean age was 38.4 years. Follow-up was min 5 months, max 23 (8.7 ave.)

ENS was used for 28 cases (25.4%). Other surgical techniques, were the Ilizarov apparatus (41 cases, 34.4%), the Grosse-Kempf locked nail (18.4%), fibular osteotomy (11%) the retrograde nail (5%), others (6%). ENS is indicated in:

3 – non unions with focuses at least 5cm. From epiphysis.

2)- serious soft tissue and bone cortical damage.

3)- failure of previous treatment.

3 – hypertrophie non unions where infection is reduced /absent and ESR is negative.

ENS is not indicated in the following conditions:

1. focus near the epiphysis;

2. severe bone loss;

3. atrophic non-unions ;

3 – active stage of the infection.

In spite of point 4, the Authors used it in 5 cases with active osteomyelitis that could not be treated otherwise.

Results: Many cases are still undergoing treatment. Recovery times are generally shorter compared to traditional Grosse-Kempff Nails and Ilizarov. Bone healing is physiological and refractures after removal have not occurred in the few nails removed. Two Patients underwent re-operation, one for a nail failure, the second for a wrong choice in the first operation. Nail breakages occurred in 4 cases (3 tibias, 1 femur). There were 3 re-infections, all among the 6 patients operated with an active form.

Conclusions: ENS is a more sophisticated nailing system, less aggressive, that reduces X-ray exposure, blood loss, surgical time. This nail offers the advantage of a dynamic GKN, controlling torsion with longitudinal bars, but with a relative weakness especially for femurs. The learning curve is brief, but without a guide-wire more care is needed. The cost is high.