Distraction Osteogenesis Technique Using an Intramedullary Nail and an External Fixator in Large Bone Defects
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Published:
Feb 17, 2023
Keywords:
Lengthening over a nail, Masquelet, bone defect
Main Article Content
Abstract
Introduction: The proper treatment of bone defects represents a challenge for the orthopedic surgeon given the difficulty in restoring limb alignment without discrepancy nor infections. Multiple techniques have been described for the reconstruction of these defects. These include bone grafting, whether autologous or from a bank, the induced membrane technique, distraction osteogenesis, and, recently, the use of trabecular titanium cylinders, but none has been shown to be significantly superior to another.
Materials and Methods: Between 2018 and 2021, ten patients with tibial bone defects were treated by guided bone transport with intramedullary osteosynthesis. We carried out a descriptive retrospective study of this series, analyzing the magnitude of the defects, the transport time, the complications and additional surgeries that took place during the process, whether there was consolidation, and the residual deformities. The bone and functional ASAMI scores were measured at the end of the process.
Results: The average length of the treated defects was 9.75 cm and the average external fixation index was 40.62 d/cm. At the end of the reconstructive process, 50% of the patients presented a good bone ASAMI score, 10% presented an excellent score, and 40% had a poor score. Regarding the functional ASAMI score, 20% were excellent, 30% were good, and 50% were poor.
Conclusion: The use of fixators guided by intramedullary nails constitutes a reliable method to treat bone defects that allows treating the infection locally and systemically, shortens the times of external fixation and hospitalization, and reduces the need for reinterventions.
Materials and Methods: Between 2018 and 2021, ten patients with tibial bone defects were treated by guided bone transport with intramedullary osteosynthesis. We carried out a descriptive retrospective study of this series, analyzing the magnitude of the defects, the transport time, the complications and additional surgeries that took place during the process, whether there was consolidation, and the residual deformities. The bone and functional ASAMI scores were measured at the end of the process.
Results: The average length of the treated defects was 9.75 cm and the average external fixation index was 40.62 d/cm. At the end of the reconstructive process, 50% of the patients presented a good bone ASAMI score, 10% presented an excellent score, and 40% had a poor score. Regarding the functional ASAMI score, 20% were excellent, 30% were good, and 50% were poor.
Conclusion: The use of fixators guided by intramedullary nails constitutes a reliable method to treat bone defects that allows treating the infection locally and systemically, shortens the times of external fixation and hospitalization, and reduces the need for reinterventions.
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How to Cite
Quesada, A., Videla Ávila, F., Horué Pontoriero, G., & Filisetti, J. E. (2023). Distraction Osteogenesis Technique Using an Intramedullary Nail and an External Fixator in Large Bone Defects. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 79-90. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1570
Section
Clinical Research
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References
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segmental defects with a rail fixation system. Strat Traum Limb Recon 2017;12:45-51. https://doi.org/10.1007/s11751-017-0278-6 e
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correction. Ann R Coll Surg Engl 2010;92(2):101-5. https://doi.org/10.1308/003588410X12518836439326
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9. Li Z, Zhang X, Duan L, Chen X. Distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Can J Surg 2009;52(2):103-11. PMID: 19399204
10. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop
1990;(250):81-104. https://doi.org/10.1097/00003086-199001000-00011
11. Masquelet AC. The induced membrane technique. Orthop Traumatol Surg Res 2020;106(5):785-7.
https://doi.org/10.1016/j.otsr.2020.06.001
12. Brinker MR, O’Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with
nonunions. J Orthop Trauma 2007;21(8):557-70. https://doi.org/10.1097/BOT.0b013e31814d4dc6
13. Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg 2015;
23(3):143-53. https://doi.org/10.5435/jaaos-d-14-00018
14. Paley D, Herzenberg JE, Paremain G, Bhave A. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 1997;79(10):1464-80. https://doi/org/10.2106/00004623-199710000-00003
15. Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury
2017;48Suppl 1:S52-S58. https://doi.org/10.1016/j.injury.2017.04.028
16. Farsetti P, De Maio F, Potenza V, Efremov K, Marsiolo M, Caterini A, et al. Lower limb lengthening over an
intramedullary nail: a long-term follow-up study of 28 cases. J Orthop Traumatol 2019;20(1):30.
https://doi.org/10.1186/s10195-019-0538-y
17. Kocaoglu M, Eralp L, Kilicoglu O, Burc H, Cakmak M. Complications encountered during lengthening over an
intramedullary nail. J Bone Joint Surg Am 2004;86(11):2406-11. https://doi.org/10.2106/00004623-200411000-00007
18. Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol
2020;21(1):3. https://doi.org/10.1186/s10195-019-0541-3
2. Trueta J. Blood supply and the rate of healing of tibial fractures. Clin Orthop Relat Res 1974;(105):11-26.
PMID: 4430159
3. Paley D. Treatment of tibial nonunion and bone loss with the Ilizarov technique. Instr Course Lect 1990;39:185-97. PMID: 2186101
4. Marsh JL, Prokuski L, Biermann JS. Chronic infected tibial nonunions with bone loss. Conventional techniques
versus bone transport. Clin Orthop Relat Res 1994;(301):139-46. PMID: 8156664
5. Gil Albarova J, De Pablos J. Técnicas de elongación ósea. Rev Esp Cir Osteoart 1992;27(161):243-9. Disponible en: http://www.cirugia-osteoarticular.org/adaptingsystem/intercambio/revistas/articulos/1545_243.pdf
6. Mudiganty S, Daolagupu AK, Sipani AK, Das SK, Dhar A, Gogoi PJ. Treatment of infected non-unions with
segmental defects with a rail fixation system. Strat Traum Limb Recon 2017;12:45-51. https://doi.org/10.1007/s11751-017-0278-6 e
7. Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. Ilizarov principles of deformity
correction. Ann R Coll Surg Engl 2010;92(2):101-5. https://doi.org/10.1308/003588410X12518836439326
8. Ilizarov GI. Angular deformities with shortening. En: Coombs R, Green S, Sarmiento A (eds). External fixation and functional bracing. London: Orthotex; 1989:359-74.
9. Li Z, Zhang X, Duan L, Chen X. Distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Can J Surg 2009;52(2):103-11. PMID: 19399204
10. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop
1990;(250):81-104. https://doi.org/10.1097/00003086-199001000-00011
11. Masquelet AC. The induced membrane technique. Orthop Traumatol Surg Res 2020;106(5):785-7.
https://doi.org/10.1016/j.otsr.2020.06.001
12. Brinker MR, O’Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with
nonunions. J Orthop Trauma 2007;21(8):557-70. https://doi.org/10.1097/BOT.0b013e31814d4dc6
13. Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg 2015;
23(3):143-53. https://doi.org/10.5435/jaaos-d-14-00018
14. Paley D, Herzenberg JE, Paremain G, Bhave A. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 1997;79(10):1464-80. https://doi/org/10.2106/00004623-199710000-00003
15. Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury
2017;48Suppl 1:S52-S58. https://doi.org/10.1016/j.injury.2017.04.028
16. Farsetti P, De Maio F, Potenza V, Efremov K, Marsiolo M, Caterini A, et al. Lower limb lengthening over an
intramedullary nail: a long-term follow-up study of 28 cases. J Orthop Traumatol 2019;20(1):30.
https://doi.org/10.1186/s10195-019-0538-y
17. Kocaoglu M, Eralp L, Kilicoglu O, Burc H, Cakmak M. Complications encountered during lengthening over an
intramedullary nail. J Bone Joint Surg Am 2004;86(11):2406-11. https://doi.org/10.2106/00004623-200411000-00007
18. Hosny GA. Limb lengthening history, evolution, complications and current concepts. J Orthop Traumatol
2020;21(1):3. https://doi.org/10.1186/s10195-019-0541-3