Abstract
Injudicious reaming of the tibial shaft can lead to extreme local hyperthermia, which in turn can result in the rare but catastrophic complication of segmental bone and soft tissue necrosis (osteocutaneous thermal necrosis). This is a retrospective study showing osteocutaneous thermal necrosis occurring after tibial intramedullary reaming salvaged by Ilizarov reconstruction in seven patients from the collective experience of four limb reconstruction centres. All patients were males, with an average age of 51.8 years (range, 30–70 years), who had undergone intramedullary reaming during the treatment of closed tibial fractures. In all patients, circumferential bone and variable contiguous soft tissue necrosis developed a few days after reaming. Bone and soft tissue reconstruction was subsequently performed using a circular external fixator (Ilizarov apparatus or Taylor spatial frame) a mean of four months after injury in six patients; in one case, reconstruction was undertaken four years after the original injury. Two complications (secondary tissue breakdown at a bone transport site; premature consolidation) necessitated cessation of bone transport at one of two bone transport levels in two patients. All patients eventually healed with a good functional result after an average of 11.5 months in the fixator (range, 10–13 months).
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We thank John Birch, MD, from the Texas Scottish Rite Hospital for Children in Dallas, Texas, USA, for great care in providing excellent revision writing.
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None of the authors have received financial support related to this study. This study was approved by the ethical review boards of A. Manzoni Hospital (Lecco), Menaggio Hospital (Como), Banaras Hindu University (Varanasi), Benha Medical School (Egypt) and Niguarda Hospital (Milan).
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Lovisetti, G., Sala, F., Thabet, A.M. et al. Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients. International Orthopaedics (SICOT) 35, 121–126 (2011). https://doi.org/10.1007/s00264-010-0952-5
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DOI: https://doi.org/10.1007/s00264-010-0952-5