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Successful limb salvage using the two-staged technique with internal fixation after osteodistraction in an effort to treat large segmental bone defects in the lower extremity

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The reconstruction of large segmental bone defects exceeding 8 cm remains a major therapeutic challenge. Strategies to avoid amputation and thereby provide satisfactory functional outcomes have not been sufficiently evaluated. Therefore, the present study reviews the clinical and functional outcomes after limb salvage.

Methods

From 1994 to 2011, a consecutive series of 12 patients with lower-limb segmental bone loss exceeding 8 cm were reviewed. Eight patients had suffered from a third-degree open fracture, whereas four patients had undergone bone resection after osteomyelitis. All patients underwent initial skeletal fixation with a simple, external frame. In six patients, the bone healed with no further stabilization after osteodistraction, while internal fixation by intramedullary nailing or plating was necessary in six patients.

Results

In reference to the clinical outcome, ten patients returned to their pre-injury activity level despite sustaining a total of 25 complications. Overall, patients with external fixator alone were at higher risk of sequelae (P = 0.014). In comparing the two groups, axis deviation at the lengthening site occurred in three patients without additional internal fixation; the only refracture occurred in this group. Generally, the size of the bone defect after debridement averaged 12.5 cm (range 8–26 cm). The mean distraction period until frame removal was 11 months (range 3.2–16.2 months). The EFI averaged 33.4 days/cm, whereas no significant differences in EFI were found between the groups.

Conclusion

We observed a reduced incidence of axial deviation and refracture in patients with large segmental bone defects who underwent an additional internal stabilization after fixation with an external frame. The two-stage technique caused no increase in infectious complications and might therefore be a preferable approach for successful limb salvage in patients suffering from large segmental bone defects exceeding 8 cm with insufficient bone formation during external fixation.

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References

  1. MacKenzie EJ, Bosse MJ, Kellam JF et al (2002) Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma 52(4):641–649

    Article  PubMed  Google Scholar 

  2. Bosse MJ, MacKenzie EJ, Kellam JF, et al (2001) A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am, 83-A(1):3–14

    Google Scholar 

  3. Helfet DL, Howey T, Sanders R, Johansen K (1990) Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res (256):80–86

  4. Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR (1999) Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg 103(4):1212–1220

    Article  PubMed  CAS  Google Scholar 

  5. Henry SL, Frome BA, Pederson WC (2009) Vascularized bone transfer for severe injury around the ankle. Microsurgery 29(5):353–360

    Article  PubMed  Google Scholar 

  6. Yajima H, Tamai S, Mizumoto S, Inada Y (1993) Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res 293:256–264

    PubMed  Google Scholar 

  7. Polyzois VD, Galanakos S, Zgonis T, Papakostas I, Macheras G (2010) Combined distraction osteogenesis and papineau technique for an open fracture management of the distal lower extremity. Clin Podiatr Med Surg 27(3):463–467

    Article  PubMed  Google Scholar 

  8. Ilizarov GA (1988) The principles of the Ilizarov method. Bull Hops Jt Dis Orthop Inst 48(1):1–11

    CAS  Google Scholar 

  9. Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37

    Article  PubMed  Google Scholar 

  10. Mankin HJ, Doppelt S, Tomford W (1983) Clinical experience with allograft implantation. The first ten years. Clin Orthop Relat Res (174):69–86

  11. Mekhail AO, Abraham E, Gruber B, Gonzalez M (2004) Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma 56(2):368–378

    Article  PubMed  Google Scholar 

  12. Fischgrund J, Paley D, Suter C (1994) Variables affecting time to bone healing during limb lengthening. Clin Orthop Relat Res (301):31–37

  13. Gustillo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458

    Google Scholar 

  14. Paley D, Maar DC (2000) Ilizarov bone transport treatment for tibial defects. J Orthop Trauma 14:76–85

    Article  PubMed  CAS  Google Scholar 

  15. Paley D, Herzenberg JE, Paremain G, Bhave A (1997) Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. J Bone Joint Surg Am 79(10):1464–1480

    PubMed  CAS  Google Scholar 

  16. Naudie D, Hamdy RC, Fassier F, Duhaime M (1998) Complications of limb-lengthening in children who have an underlying bone disorder. J Bone Joint Surg Am 80:18–24

    PubMed  CAS  Google Scholar 

  17. Kocaoglu M, Eralp L, Kilicoglu O, Burc H, Cakmak M (2004) Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg Am 86-A(11):2406–2411

    Google Scholar 

  18. Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov Technique. Clin Orthop 250:81–104

    PubMed  Google Scholar 

  19. Lai KA, Lin CJ, Chen JH (2002) Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis. J Bone Joint Surg Br 84(8):1145–1149

    Article  PubMed  CAS  Google Scholar 

  20. Simpson AH, Kenwright J (2000) Fracture after distraction osteogenesis. J Bone Joint Surg Br 82:659–665

    Article  PubMed  CAS  Google Scholar 

  21. Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S (2008) Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res 466(12):2923–2932

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Trauma Surgery, General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    J. Koettstorfer, M. Hofbauer & G. E. Wozasek

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  1. J. Koettstorfer
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  2. M. Hofbauer
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  3. G. E. Wozasek
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Correspondence to G. E. Wozasek.

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Koettstorfer, J., Hofbauer, M. & Wozasek, G.E. Successful limb salvage using the two-staged technique with internal fixation after osteodistraction in an effort to treat large segmental bone defects in the lower extremity. Arch Orthop Trauma Surg 132, 1399–1405 (2012). https://doi.org/10.1007/s00402-012-1564-x

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