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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 22 - 22
1 Jun 2023
North A Stratton J Moore D McCann M
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Introduction

External fixators are attached to bones with percutaneous pins and wires inserted through soft tissues and bone increasing the risk of infections. Such infections compromise patient outcomes e.g., through pin loosening or loss, failure of fixator to stabilise the fracture, additional surgery, increased pain, and delayed mobilisation. These infections also impact the healthcare system for example, increased OPD visits, hospitalisations, treatments, surgeries and costs. Nurses have a responsibility in the care and management of patients with external fixators and ultimately in the prevention of pin-site infection. Yet, evidence on best practices in the prevention of pin-site infection is limited and variation in pin-site management practices is evident. Various strategies are used for the prevention of pin-site infection including the use of different types of non-medicated and medicated wound dressings. The aim of this retrospective study was to investigate the use of dry gauze or iodine tulle dressings for the prevention of pin-site infections in patients with lower limb external fixators.

Methodology

A retrospective study of patients with lower limb external fixators who attended the research site between 2015–2022. Setting & Sample: The setting was the outpatient's (OPD) orthopaedic clinic in a University Teaching Hospital in Dublin, Ireland. Eligibility Criteria:

Over the age of 16, treated with an Ilizarov, Taylor Spatial frame (TSF) or Limb Reconstruction System (LRS) external fixators on lower limbs,

Pin-sites dressed with dry gauze or iodine tulle,

Those with pre-existing infected wounds close to the pin site and/or were on long term antibiotics were excluded.

Follow Up Period: From time of external fixator application to first pin-site infection or removal of external fixator. Outcome Assessment: The primary outcome was pin-site infection, secondary outcomes included but were not limited to frequency of pin-site infection according to types of bone fixation, frequency of pin/wire removal and hospitalisation due to infection. Data analysis: IBM SPSS Version 25 was used for statistical analysis. Descriptive and inferential statistics were conducted as appropriate. Categorical data were analysed by counting the frequencies (number and percentages) of participants with an event as opposed to counting the number of episodes for each event. Differences between groups were analysed using Chi-square test or Fisher's exact test, where appropriate. Continuous variables were reported using mean and standard deviations and difference analysed using a two-sample independent t-test or non-parametric test (Mann-Whitney), where appropriate. Using Kaplan-Meier, survival analysis explored time to development of infection. Ethical approval: granted by local institute Research Ethics Committee on 12th March 2018.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 405 - 405
1 Jul 2010
O’Toole P Noonan M North A Stratton J Kiely P Noel J Fogarty E Moore D
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Introduction: Bone transport, or distraction osteogenesis, is a recognised technique to reconstruct extensive bony defects resulting from excision of bony tumours. Ilizarov demonstrated bone formation under tension allowing the movement of a free segment of living bone to fill intercalary defects. This study assesses the use of bone transport in the management of patients with resectable long bone tumours.

Methods: We retrospectively reviewed patients who underwent bone transport in two institutions, performed by a single surgeon. A total of 14 patients were included in the study. There were 11 males and 3 females. Histological results demonstrated osteosarcoma (n=7), Ewing’s sarcoma (n=6), and parosteal chondrosarcoma (n=1). The site of the tumour was the femur and tibia in 8 and 6 cases respectively.

Results: Bone transport was fully completed in 9 patients. Of the 5 patients remaining, 3 are currently in cast, 1 is currently undergoing tibial lengthening, and 1 patient died from local recurrence and distant spread of disease. The average length of bone resected in the tibia was 11 cm (range 8–15 cm), while in the femur the average was higher at 16.5 cm (range 12–27 cm). All patients underwent autologous bone grafting of their docking site from either the anterior or posterior iliac crest on the ipsilateral side. The average time in frame was 24.8 months. One patient undergoing tibial bone transport fell and sustained an ipsilateral supracondylar femoral fracture which was successfully treated with an external ring fixator.

Discussion: Bone transport is a recognised method of reconstructing extensive bony defects and is beneficial for patients with a good prognosis. It is a specialised technique and requires a multidisciplinary approach. Other techniques can be less time consuming however distraction osteogenesis avoids the complications associated with prosthetic or allograft replacements.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 130 - 130
1 Feb 2004
O’Shea K Sedhom M Mofidi A North A Stratton J Moore D
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The management of long bone infected non-unions; posttraumatic chronic osteomyelitis and primary segmental bone defects constitute some of the most difficult reconstructive challenges encountered by orthopaedic surgeons. Measures employed to treat these conditions are tantamount to limb salvage with amputation a likely outcome if reconstructive endeavors prove unsuccessful. The Ilizarov method of distraction osteogenesis and bone transport, following radical debridement in the case of infection, is one potential management option in such cases.

Aim: To assess outcome in a cohort of patients with long bone defects treated with this technique.

Methods: Clinical review coupled with retrospective chart study and radiographic assessment.

Results: 24 patients (20 adults, 4 children) underwent treatment over a 6-year period. 21 had defects of a primary traumatic aetiology (18 tibial and 3 femoral fractures). The mean interval between injury and commencing bone transport was 41.6 months. The mean defect dimension requiring transport was 9cm (range 4.5 to 28cm). The mean external fixation time was 14.6 months. Union occurred in 21 cases. Autologous bone grafting of the docking site was performed in 6 cases in order to stimulate union. Following removal, frames were reapplied in 4 cases due to refracture or development of angular deformity. Two patients proceeded to below knee amputations. According to ASAMI* criteria, the bone result was excellent in 12 patients, good in 5 patients, fair in one patient and poor in 6 patients. Functional outcome was excellent in 7 patients, good in 12, fair in 2 and poor in 3.

Conclusion: The Ilizarov method of bone transport is a reliable procedure providing consistent results in complex cases when frequently alternative treatment options have been exhausted. Outcome compares favorably with other treatment modalities such as vascularised free tissue transfer or Papineau type grafting procedures. The treatment period is lengthy and both major and minor complications are common but limb salvage is successful in the main part. More aggressive treatment and appropriate fracture management in the early stages may have a role to play in improving the prognosis of these patients.

*Association for the Study and Application of the Methods of Ilizarov