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Management of Infected Nonunion of Long Bones, A Case Series
Keywords:
Long bones, Infected nonunion, IlizarovAbstract
Objective: To evaluate the management of long bones infected nonunion.
Methods: This retrospective study was conducted between July 2014 and July 2017. Inclusion criteria was to include all cases of infected nonunion of long bones with no evidence of union within six to eight months, irrespective of loss of bone. All patients were thoroughly investigated and evaluated clinically, labs and X-rays. All patients were assessed by the Association for the Study and Application of Methods of Ilizarov(ASAMI) criteria for radiological and functional outcomes.
Results: In this study, Twenty cases of infected nonunion (tibia 14, and femur 6) were used. There were 14 males and 6 female subjects, for whom the average age was 35±6.21 SD (range 18-52). 15 patients had open fracture while 5 patients were post internal fixation. Infection was eradicated and the union was achieved in all cases. The average time to union was a mean of 10±1.1SD months, ranging from 8 to 12 months). The follow up was a mean of 18 months (range 16-20 months). In case of tibia and femur as per the ASAMI score, radiological results were excellent in 14/20 (70%) and good in 4/20 (20 %), 2/20 (10%) showed fair results and no patient had poor result. Functional outcomes were excellent in 13/20 (65%) subjects, 5/17 (25%) were rated as good, and 2/20 (10%) as fair. Union was achieved in all three cases of humerus.
Conclusion: Infected non-unions pose challenge to both patient and surgeon. Ilizarov fixator gave good and excellent results in complex non-union of long bones by eradicating infection, filling the defect with bone transport and correcting the deformity.
References
2. Bansal A, Bansal S, Singh R, Walia JP, Brar BS. Role of Ilizarov ring fixator in infected nonunion tibia. Int J Med Dent Sci 2014 Jul;3:451-9.
3. Yu P, Zhang Q, Mao Z, Li T, Zhang L, Tang P. The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg 2014 Sep;80:426-35.
4. Menon DK, Dougall TW, Pool RD, Simonis RB. Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma 2002 Aug;16:491-7.
5. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 1989 Apr;241:146-65.
6. Ferreira N, Marais LC. Prevention and management of external fixator pin track sepsis. Strategies Trauma Limb Reconstr 2012 Aug;7:67-72.
7. Harshwal RK, Sankhala SS, Jalan D. Management of nonunion of lower-extremity long bones using mono-lateral external fixator–Report of 37 cases. Injury. 2014 Mar;45(3):560–7.
8. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG, Singh J. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma. 2012 Mar;26(3):184–8.
9. Rose RE, Palmer WS. The Illizarov method in infected non-union of long bones. West Indian Med J. 2007 Jun;56(3):246–51.
10. Jain AK, Sinha S. Infected nonunion of the long bones. Clin Orthop Relat Res. 2005 Aug;431:57– 65.
11. Madhusudhan TR, Ramesh B, Manjunath K, Shah HM, Sundaresh DC, Krishnappa N. Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions - a prospective study. J Trauma Manage Outcomes. 2008 Jul;2(1):6
12. Gustilo RB. Management of infected fractures. Surg. Musculoskeletal Syst 1990; 5:4429.
13. Rashed RE, Nigm MA, Elaziz MA, Shaheen E, Kandeel MR. Management of infected nonunions by using antibiotic-impregnated bone cement. The Egyptian Orthopaedic Journal. 2016 Jan 1;51(1):26.
14. Meyer S, Weiland AJ, Willeneger H. The treatment of infected non-union of fractures of long bones. J Bone Joint Surg. 1975 Sep;57A:836–842.
15. Lei H, Yi L. One-stage open cancellous bone grafting of infected fracture and nonunion. J Orthop Sci. 1998;3(6):318–23.
16. Yajima H, Tamai S, Mizumoto S, Inada Y. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res. 1993 Aug;293:256–64.
17. Yin P, Zhang Q, Mao Z, Li T, Zhang L, Tang P. The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg. 2014 Sep;80(3):426–35.
18. Dhanasekhar R, Jacob PJ, Francis J. Antibiotic cement impregnated nailing in the management of infected non-union of femur and tibia. Kerala J Orthop 2013; 26:93–97.
19. Fan C-Y, Hsieh M-S, Chen W-M, Chen C-F. Successful management of infected intramedullary nailing with reaming, lavage, and insertion of antibiotic-impregnated cement rods. J Exp Clin Med 2011 Jun;3:137–141.
20. Chen CE, Ko JY, Wang JW, Wang CJ. Infection after intramedullary nailing of the femur. J Traum2003 Aug;55:338–344.
21. Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma 2007; 21:258–268.
22. Babhulkar S, Pande K. Nonunion of the diaphysis of long bones. Clin Orthop Relat Res 2005 Apr;431:50–56.
23. Struijs PA, Poolman RW, Bhandari M. Infected Nonunion of the Long Bones. J Orthop Trauma. 2007 Aug;21(7):507-11.
24. Pande H, Singh CM, Prabhakara A, Philipa VM, Iqbal MS, Sharma Y. Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes. Int J Res Orthop 2017;3:557-64.
25. Sala F, Thabet AM, Castelli F, Miller AN, Capitani D, Lovisetti G, et al. Bone transport for postinfectious segmental tibial bone defects with a combined Ilizarov/Taylor Spatial Frame technique. J Orthop Trauma. 2011 Mar;25(3):162–8.
26. Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br. 2006 Jul;88(7):928-32.
27. Chattopadhyay P, Mandal P, Sabui KK, Banka PK. Treatment of Difficult Non-union of Long Bones using the Ilizarov Technique. Int J Sci Stud 2017 Mar;4(12):27-30.
28. Khan MS, Raza W, HidayatUllah, Khan AS, Siraj, M, Askar Z. Outcome of Ilizarov fixator in complex non-union of long bones. J Pak Med Assoc. 2015 Nov;65(11 Suppl 3):S147-51.
