Abstract
Purpose: End results analysis of surgical treatment of posttraumatic bone defects in the lower extremity by Ilizarov method and intramedullary nailing augmentation during consolidation.
Materials and method: Between 1990–2000,83 patients with posttraumatic bone defect (femur 26, tibia 57) with an average age of 38 years (11–65y.) were surgically treated. Open fracture was the cause of bone defect in 50 patients (60%). In the rest 33 (40%) patients, the bone defect was the result of a surgical removal of a nonviable bone due to osteomyelitis or infected non-union. The average length of bone defect was 8,5 cm. (4–20 cm.). In all cases corticotomy and application of Ilizarov device was necessary to initiate bone transport. In 26 patients the Ilizarov device was removed during consolidation and interlocking intramedullary nailing was performed. Selection criteria for changing method were: 1) delayed union at the docking site (13 pt.), 2) Intolerance of the Ilizarov device (6 pt.), 3) Angular deformity > 10 degrees (7 pt.). Radiological and clinical assessment was performed periodically. Functional recovery and bone healing were evaluated according to A.S.A.M.I criteria.
Results: Forty-eight patients (58%) presented delayed union at the docking site. In 35 patients compression- distraction was necessary to promote union. The rest 13 patients were healed using an interlocking intramedullary nailing. Three refractures needed reapplication of the Ilizarov device. Angular deformity of more than 10 degrees was found in 13 patients. Seven of them needed an osteotomy and intramedullary nailing. All bone defects were finally covered and solid bone formation resulted.
Conclusions: The Ilizarov method offers unique advantages in treatment of bone defects. The use of an interlocking intramedullary nail during consolidation, is a treatment option for delayed docking site union and prolonged treatment time.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
