Abstract
Introduction: Bone defects in septic cases can be caused by the septic process itself or by resection of bone segments. For the budging of segmental defects, segmental bone transport is an alternative method which has been used at our department since 16 years.
For the surgical reconstruction of bone defects there are several options:
Method: Segmental consists of removing all dead bone, then stabilizing the limb by the use of an external fixator and to perform a corticotomy at the proximal or distal metaphysical area followed by bone segment transport, by gradual distraction.
Gradual distraction stimulates active bone regeneration and due to increased vascularisation also healing of the chronic infectious process. The mechanical lengthening device must insure stability.
As soon as both bone ends get into contact a docking manoever has to be performed to remove soft tissues between the bone ends and to stimulate healing by drilling of the bone ends with a k-wire and eventually adding cancellous bone grafts.
The external fixator is kept in place until full bone consolidation is accomplished.
Segmental bone transport can be performed by using monolateral fixators, by intramedullary nails (e.g. fit-bone) and by circular frame fixators like the conventional Illizarov or the new Taylor Spatial Frame.
Our preferred technique is the Weber cable technique with TSF which allows an ideal guidance of the segment to the docking site without cutting through the skin.
Results: At the paediatric orthopaedic department of the Speising hospital Vienna we have treated 32 cases of septic bone defects using different types of external fixators, segmental transport and also external fixation in combination with vascularised fibula transfer.
In all but 2 cases fusion and healing of chronic infection of bone and soft tissues could be achieved. In the 2 cases which could not be treated successfully an amputation had to be performed.
Conclusion: The treatment of segmental bone defects using external fixation and segmental bone transport has proved to be very effective. Gradual distractions of living tissues creates stresses which increase the blood supply and stimulate not only bone healing but also the healing of infection.
Correspondence should be addressed to Vienna Medical Academy, Alser Strasse 4, A-1090 Vienna, Austria. Phone: +43 1 4051383 0, Fax: +43 1 4078274, Email: ebjis2009@medacad.org
