ABSTRACT
Objective To assess the clinical curative effect of accordion technique in the treatment of tibial delayed union or nonunion.Methods From February 2016 to December 2017,data of 11 patients with tibial delayed union (n=8) or non-union (n=3) who had been treated by accordion technique with an Ilizarov ring external fixator were retrospectively analyzed.10 males and 1 female were included in our study,with an average age of 41.9 years (range,21-63 years).There were 5 cases of docking site delayed union after Ilizarov transport for chronic tibial osteomyelitis.There were 3 cases of fracture site delayed union after external fixation for open tibia comminuted fracture.There were 3 cases of nonunion after tibia closed fracture,including 2 cases who had hybrid external fixation treatment,and 1 case who had conservative treatment.All the cases received accordion technique using Ilizarov ring external fixators.First,gradual compression at the fracture site was conducted until the bony contact was seen on a radiograph.After bony contact,compression was continued at a rate of 0.85 mm/d for a week,followed by distraction of 0.85 mm/d for 2-3 weeks.Afterward,a second compression was conducted using same rate and time with the distraction procedure.And there was a 7-day latent period between compression and distraction.One or two cycles of compression-distraction were needed before union was present radiographically.Results Bony union was obtained in all 11 patients after a mean time of 5.4 months (from 3 to 9 months).The mean follow-up for the 11 patients was 15.2 months (from 11 to 29 months).The mean duration of the accordion technique treatment was 50.2 d (range,35-67 d).The accordion technique was used 1 time for 8 patients,and 2 times for 3 patients.The mean duration of bone consolidation was 114.9 d (range,64-239 d).According to Paley evaluation criteria,osseous results were excellent in 8 cases,good in 3 cases,with a good to excellent rate of 100％(11/11);functional results were excellent in 7 cases,and good in 4 cases,with a good to excellent rate of 100％(11/11).Conclusion The accordion technique is a minimal invasive,safe and reliable treatment program for tibial delayed union or nonunion.
ABSTRACT
<p><b>OBJECTIVE</b>To discuss clinical outcomes of accordion operation for the Ilizarov technique in treating tibial bone defects.</p><p><b>METHODS</b>From January 2014 to June 2016, 22 patients with tibial bone defects were treated by Ilizarov bone-transport technique, including 19 males and 3 females with an average age of 44.04 years old ranging from 23 to 60 years old;the length of the bone defects before the bone transport was 5 to 11 cm with an average 7.68 cm; Cause of injury invlved traffic accidents in 14 cases, fall injury in 3, smashing injury in 4, high drop injury in 1; 6 cases were on the left and 16 cases were on the right. The patients were divided into two groups: 11 cases in accordion group were treated by "accordion operation" after bone transport was completed;11 cases in control group were treated by the external fixator locked waiting for bone consolidation after bone transport was completed. All patients were followed up for 18 to 36 months with an average time of 27.9 months. There was no statistical significance between two groups, such as sex, age, length of bone defect(>0.05). Analysis of healing time, healing index and other indicators, and Paley's criterion was used to evaluate the healing effect of bone healing and function recovery of the limb.</p><p><b>RESULTS</b>The result of X-ray evaluation was all patients achieved bone healing. In accordion group, the bone healing time was (365±91) days, the bone healing index was (46.2±3.5) d/cm; in control group, the bone healing time was(435±108) days, the bone healing index was (57.8±3.5) d/cm. There was no statistical significance in the bone healing time between the two groups(=1.648, =0.115);There was statistical significance in the bone healing index between the two groups(=7.754, =0.000). At the final follow-up, according to Paley's criterion, the result in accordion group was excellent in 9 cases, good in 2 cases; in control group, excellent in 8 cases, good in 3 cases. Score was not statistically significant(=-0.479, =0.619). Complications involved nail infection (9 cases in accordion group, 10 cases in control group);local traction pain (2 cases in accordion group, 1 case in control group); axial malalignment>10°(4 cases in accordion group, 3 cases in control group);location difference of the junction of bone defects (3 cases in accordion group, 2 cases in control group);Complications were not statistically significant(>0.05).</p><p><b>CONCLUSIONS</b>Accordion operation for the Ilizarov technique in treating tibial bone defects can shorten the treatment time and consolidation time, and improve the healing index.</p>