|
 
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| CASE REPORT |
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| Year : 2016 | Volume
: 16
| Issue : 2 | Page : 159-161 |
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Ilizarov ring fixator in treatment of infected nonunion of tibia
Arnab Kumar Samanta1, Soumya Ghosh1, Arunima Chaudhuri2, Sudip Chandra Mondal1
1 Department of Orthopedics, BMCH, Burdwan, West Bengal, India
2 Department of Physiology, BMCH, Burdwan, West Bengal, India
| Date of Web Publication | 13-Apr-2016 |
Correspondence Address:
Dr. Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-6308.180189
Infective nonunion of a long bone is very notorious to be treated and prone to limb shortening when treated by conventional methods. In this case report, we treated a patient having infected nonunion of tibia initially by complete excision of all devitalized tissue from site of nonunion causing bone gap of 7 cm, followed by application of Ilizarov ring fixator using bifocal osteosynthesis by single upper tibial osteotomy. Bone transportation done at a rate of 1 mm/day followed by compression-distraction at the nonunion site following accordion maneuver. Results showed satisfactory bony union by bifocal osteosynthesis with single osteotomy. حلقة الزاروف المثبتة في علاج عظم الساق الاعظم الملهتب وغير الملتئم:
خلفية البحث: من الشائع عند علاج العظم الطويل الملتهب وغير الملتئم سوء برئه وقابليته لتقصير الطرف حين يتم علاجه بواسطة الطرق التقليدية. في تقرير هذه الحالة عالجنا مريضا يعاني من عدم التئام والتهاب لعظم الساق الأعظم اولياً باستئصال لجميع الانسجة التالفة من موضع عدم الالتئام مما ادى الى نقصان 7سم من العضل تبعه استخدام لحلقة الزاروف المثبتة باستخدام تصنيع العظم ثنائي البؤرة عن طريق الاستئصال الاحادي العلوي لعظم الساق الاعظم. تم اجراء نقل العظم بمعدل 1mm يوميا تبع بالضغط والتهشيم في الموضع غير الملتئم بطريقة اوكورديون. اظهرت النتائج التئام مرضي لتصنيع العظم ثنائي البؤرة مع استئصال فردي للعظم. Keywords: Fracture tibia, Ilizarov ring fixator, nonunion
How to cite this article:
Samanta AK, Ghosh S, Chaudhuri A, Mondal SC. Ilizarov ring fixator in treatment of infected nonunion of tibia. Saudi J Sports Med 2016;16:159-61 |
How to cite this URL:
Samanta AK, Ghosh S, Chaudhuri A, Mondal SC. Ilizarov ring fixator in treatment of infected nonunion of tibia. Saudi J Sports Med [serial online] 2016 [cited 2023 May 31];16:159-61. Available from: https://www.sjosm.org/text.asp?2016/16/2/159/180189 |
| Introduction | |  |
Fractures of long bones are not only complex surgical problems but also chronic and at times debilitating conditions. Nonunion of long bones is not only a source of functional disability but also can lead to economic hardship and loss of self-esteem. The incidence seems to be increasing, especially in view of increasing high-velocity trauma, which is more frequently treated with internal fixation. [1],[2],[3],[4],[5],[6]
Chronic infection of the diaphyseal shaft of long bones is one of the most perplexing dilemmas in orthopedic surgery. To obtain eradication of the infection, bony union, and a functional extremity often requires courageous measures with increasing risks of failure or amputation. Standard principles of debridement and antibiotic therapy alone may result in an acceptable cure rate of less severe types of infections. Difficult or resistant infections usually require a more radical debridement of the septic bone and soft tissues in addition to the application of stable fixation to enhance soft tissue healing and bony union. There are many alternatives available in the management of chronic diaphyseal infection. These include extensive debridement and local soft tissue rotational flaps, packing the defect with antibiotic impregnated beads. [2],[3],[4],[5],[6],[7],[8] Papineau-type open cancellous bone grafting, tibiofibular synostosis, cancellous allograft in fibrin sealant mixed with antibiotics, and/or free microvascular soft tissue and bone transplants. All these treatments have variable rates of success and failure and are limited in their ability to re-establish extremity length and correct deformity. The definitive environment required for many of these techniques to achieve their maximum bone grafting potential prerequisites the extremity to be free of infection and have acceptable soft tissue coverage. [2],[3],[4],[5],[6],[7],[8],[9] Many of these techniques also lack, to varying degrees, the ability to provide early functional rehabilitation of the limb during treatment. [2]
In the following report, we describe our successful experience in the treatment of infected tibial nonunion by bone transport using Ilizarov external fixator. Two hypotheses are proposed: (1) Ilizarov methods in the treatment of infected tibial nonunion can acquire satisfied effects in bone results and functional results. (2) Radical debridement is the key step to control bone infection. [3]
| Case Report | | |
A 45-year-old male patient suffered from a road traffic accident on the 17 th of August 2013 leading to Gustilo type II open fracture right midshaft tibia. He was treated by open reduction and internal fixation with 4.5 mm dynamic compression plate and bone grafting 2 days after injury in a private institute. He was discharged on the 7 th day with a poor skin condition and pus discharge from the operative site. He was admitted in our institution 10 months after the first surgery with infected nonunion of right both bone leg with exposed bone and plate at the fracture site.
Operative procedure
In supine posture, under spinal anesthesia, we removed the plate, all necrosed bone was resected until punctate bleeding was seen at bony ends to make fracture end freshened. Ilizarov ring fixator was applied two ring above and rings below fracture site maintaining limb length with a gap at fracture site of 7 cm. One 2.5 mm rush nail was introduced from proximal to distal fragment to maintain bony alignment during bone transport. After complete stabilization, upper tibial corticotomy was done in between first and second ring.
Postoperative follow-up
Seven days we started bone transportation, initially 1 mm/day, later reduced to the rate of 0.5 mm/day according to the pattern of regenerated bone column at corticotomy site. Four months after transported bone reached the target site, we started compression-distraction after releasing tethered skin at fracture site according to accordion maneuver. After solid consolidation, fixator was removed 1 year later. Leg guard applied for another 3 months.
| Results | | |
There was no distal residual neurovascular deficit in affected limb. No limb length discrepancy was found.
| Discussion | | |
Ilizarov apparatus is a very good option for treating infected nonunion with a huge bone gap. [10],[11],[12],[13],[14] It can be done either by trifocal osteosynthesis or bifocal osteosynthesis. Usually, up to 5 cm of bone gap can be lengthened using bifocal osteosynthesis. [10],[11],[12],[13],[14],[15] When bone gap >5 cm, it is treated with bifocal osteosynthesis, bony sclerosis occurs in fracture end during bone transportation which prevents union at the fracture site. [10],[11],[12],[13],[14],[15],[16] Hence, bone gap >5 cm may be treated with trifocal osteosynthesis to reduce time required for bone transportation as the treatment with Ilizarov ring fixator in the present case yielded significant positive results.
| Conclusion | | |
Bifocal osteosynthesis using Ilizarov ring fixator may be used to treat bone gap more than 5 cm in infected nonunion of tibia.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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