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Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.
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Objective:To investigate the clinical effects of Ilizarov external fixation combined pedicle flap transfer in the treatment of infected tibial nonunion plus soft tissue defects.Methods:A retrospective study was performed to analyze the data of 35 patients with infected tibial nonunion plus soft tissue defects who had been admitted to Department of Orthopedic Trauma, Tianjin Hospital Affiliated to Tianjin University from July 2005 to July 2020. There were 25 males and 10 females with an age of (37.5±6.0) years. Their original traumas were 27 open and 8 closed fractures, with a disease course ranging from 8 to 42 months. Three patients had undergone 1 operation, 7 patients 2 operations, and 25 patients 3 or more operations. All patients presented with different degrees of skin and soft tissue defects or bone exposure, wound sinus formation and bone scaring. The size of pedicle flaps transferred ranged from 6 cm×5 cm to 15 cm×10 cm. Surgical transfer of skin flap and external fixation were performed at one stage in 25 patients while staged surgery was performed in 10 patients. The first stage consisted of local debridement, vacuum sealing drainage, and delayed flap operation while the second stage consisted of delayed flap transfer and Ilizarov external fixation. The survival of skin flap, limb shortening, bony union and complications were observed after operation. The limb function was evaluated according to the criteria of The Association for the Study and Application of Methods of Ilizarov (ASAMI) for bone and functional results.Results:All patients were followed up for (23.8±7.4) months. Fracture union was achieved in all. The flaps survived postoperatively, the wounds were repaired by the first intention, infection did not recur, and bony union was achieved in 32 patients. Partial necrosis of the flap edge occurred in 3 cases, but responded to dressing change. In the 10 patients undergoing delayed flap operation, 100% of the flaps survived. In all patients, the limbs were shortened by (0.8±0.1) cm, and the tibial fractures got united after (7.2±1.2) months. By the ASAMI criteria for bone results, 29 cases were excellent and 6 cases good; by the ASAMI criteria for functional results, 25 cases were excellent, 8 cases good, and 2 cases fair.Conclusion:As Ilizarov external fixation combined pedicle flap transfer can repair bone and soft-tissue defects at the same time, this surgical scheme facilitates infection control and leads to reliable outcomes.
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Objective:To compare the clinical effect of circular external fixator and intramedullary nail in treatment of tibial segmental fractures.Methods:A retrospective case control study was performed on clinical data of 43 patients with segmental tibial fractures treated from January 2006 to December 2012 in Tianjin Hospital. There were 31 males and 12 females with age range of 20-60 years［（35.9±9.6）years］. All fractures were classified as type 42C2 using the AO/OTA classification. A total of 21 patients treated with circular external fixator（circular fixator group）and 22 patients were treated with intramedullary nail（intramedullary nail group）. The condition of vascular and neural injuries，methods of fracture reduction，time of full weight bearing，bone healing time and infection rate were compared between the two groups. The proximal tibial medial angle，proximal tibial posterior angle，IOWA knee and ankle joint score，range of motion of flexion of keen joint and range of motion of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last follow-up.Results:All patients were followed up for 12- 48 months［（19.6±2.1）months］. There were no vascular and neural injuries or other severe complications in both groups. All 21 patients in circular fixator group underwent closed reduction but 3 patients in intramellary nail group were treated by open reduction. The time of full weight bearing was（12.9±2.8）days and in circular fixator group and（75.1±8.0）days in intramedullary nail group（ P<0.05），with bone healing time for（7.0±1.0）months and（8.2±1.4）months，respectively（ P<0.05）. There was no deep infection in both groups. In circular fixator group and intramedullary nail group，the proximal tibial medial angle was（86.7±1.5）° and（93.5±1.7）°（ P<0.05），while the proximal tibial posterior angle was（82.1±1.8）°and（75.1±2.7）°（ P<0.05）. No significant differences were found between the two groups at the last follow-up concerning IOWA knee and joint score，range of motion of flexion of keen joint and range of motion of plantar flexion of ankle joint（ P>0.05）. The range of motion of dorsal flexion of ankle joint in intramedullary nail group was（30.9±3.0）°，better than（21.2±2.2）° in circular fixator group（ P<0.05）. Conclusion:For segmental tibial fractures，cirlular external fixation is superior to intromedullary nail in aspects of completely close reduction，early full weight bearing and early bone healing and alignment.
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Treatment of large bone defects and nonunion induced by various causes requires bone graft, and autologous iliac bone graft has always been considered as the gold standard for the treatment of bone transplantation. However, there exist problems such as postoperative pain and numbness in the donor area or insufficient bone taking. The application of reamer-irrigator-aspirator（RIA）technique can reduce complications in the donor area and collect a maximum of 90 ml of autologous bone to treat large bone defects. In addition, it can also be used to remove the infected lesion and residual bone cement in the medullary cavity. The authors review the instrument structure, operation process, clinical application and complications of RIA technique, so as to provide a reference in the treatment of bone defects and intramedullary canal infection.
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Objective:To compare the biomechanical properties of different circular external fixators for the fracture site of oblique long bone fractures.Methods:15 polyethylene (PE) plastic rods with the same batch were selected to make the model of oblique fractures in the middle of long bones. According to the connection between PE rods and external fixators, the PE rods were randomly divided into: the group that was simply used kirschner wires (group kirschner wires), the group that was simply used olive wires (group olive wires), the group that was simply inserted half pins (group half pins), the group that was inserted single cortical fixed half pins at either side of the fracture site after being fixed by the tensioned olive wires (group olive wires+ half pin), the group that was inserted tensioned trans-fracture olive wires after being fixed by the tensioned olive wires (group olive wires+ olive wires). The axial compression tests were carried out, and the interfragmentary displacements under axial loads of 200 N, 400 N, 600 N and 800 N were measured and the axial stiffness was calculated. Then, the torsional tests were carried out, and the interfragmentary torsional angles were measured under torsional loads of 4 N·m, 7 N·m and 10 N·m, and the torsional stiffness was calculated.Results:With the increase of axial load from 200 N to 800 N, the axial interfragmentary displacement in each group gradually increased. The interfragmentary axial displacement of each group in ascending order was: group olive wires+ olive wires, group olive wires+ half pins, group half pins, group olive wires, group kirschner wires. The axial stiffness of each configuration under 800 N axial load in descending order was: group olive wires+ olive wires [863.93 (824.32, 875.87) N/mm], group olive wires+ half pins [119.92 (113.16, 123.58) N/mm], group half pins [81.92(79.42, 82.40) N/mm], group olive wires [76.83 (72.45,79.47) N/mm], group kirschner wires [70.80 (67.49, 71.59) N/mm]. The pairwise comparisons of the axial stiffness data of each configuration had statistical significance (all P <0.05). With the increase of the torque load from 4 N·m to 10 N·m, the interfragmentary rotational angle in each configuration gradually increased. The interfragmentary torsion angle of each group in ascending order was: group half pins, group olive wires+ olive wires, group olive wires+ half pins, group olive wires, group kirschner wires. The torsional rigidity of each configuration under 10 N·m torsional load in descending order was: group half pins [1.80 (1.63, 1.85) N·m/°], group olive wires+ olive wires [1.05 (1.02, 1.07) N·m/°], group olive wires+ half pins [0.99 (0.98, 1.03) N·m/°], group olive wires [0.81 (0.78, 0.82) N·m/°], group kirschner wires [0.75 (0.74, 0.76) N·m/°]. The pairwise comparisons of the torsional rigidity data of each configuration had statistical significance (all P < 0.05). Conclusion:The axial stiffness and torsional stiffness of circular external fixators can be increased by using tensioned olive wires or half pins at the fracture site. Due to the insufficient support between oblique fracture site, when the load is applied, the axial displacement and torsion angle of the fracture site will still be fairly large after being fixed the fracture site with half pins. Treating with tensioned trans-fracture olive wires after being fixed by the tensioned olive wires at either side of the fracture site can effectively control the interfragmentary shear and displacement, thus providing an ideal mechanical environment for fracture healing.
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Objective:To investigate the accuracy and postoperative efficacy of fluoroscopy and CT in measuring the mounting parameters of Taylor Spatial Frame.Methods:Data of patients with peripheral knee deformities who were treated by Taylor Spatial Frame from June 2006 to December 2017 were retrospectively analyzed. According to different measurement methods of mounting parameters, they were divided into fluoroscopy group (mounting parameters were obtained by intraoperative fluoroscopy) and CT group (mounting parameters were obtained by postoperative CT). There were 33 patients (35 segments) in the fluoroscopy group, 23 males (23 segments) and 10 females (12 segments), with an average age of 36.4±11.6 years old. In CT group, there were 30 patients, 19 males and 11 females, with an average age of 36.9±13.8 years. There were 22 cases (24 segments) of high tibial osteotomy, 5 cases (5 segments) of distal femur osteotomy, and 6 cases (6 segments) of both distal femur and high tibial osteotomy. Operation time, external fixation time, the number of electronic prescription and deformity correction time, mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), mechanical lateral distal femoral angle (mLDFA), range of motion (ROM) andhospital for special surgery (HSS) knee functional scores were compared between the two groups.Results:All the 63 patients were followed up for 21.9 months (range, 12-60 months). In fluoroscopy group, operating time was 100.9±9.1 min, electronic prescription number 1.4±0.6, and deformity correction time was 19.4±3.6 days. In CT group, operating time was 79.2±10.8 min, electronic prescription number 1.2±0.4, and deformity correction time was 16.0±4.4 days. The difference of the above indexes between the two groups was statistically significant ( t=8.803, 2.042, 3.440, all P < 0.05). In the fluoroscopy group, the external fixation time was 4.8±0.9 months; MAD was 4.3±2.1 mm; MPTA was 88.5°±1.9°; mLDFA was knee 89.2°; ROM was 122.4°±3.9° and HSS score was 90.0±3.6. In CT group, the external fixation time was 4.6±0.9 months; MAD was 4.0±1.9 mm; MPTA was 87.8°±1.7°; mLDFA was knee 88.6°; ROM was 122.7°±3.4° and HSS score was 91.1±2.9. There was no statistically significant difference in the above indexes between the two groups (all P >0.05). In the fluoroscopy group, 22 segmental deformities were corrected by one electronic prescription, and 13 segmental deformities were corrected by two or more electronic prescriptions. In CT group, 25 segmental deformities were corrected by one electronic prescription, and 5 segmental deformities were corrected by two electronic prescriptions. There was no incision infection and no neurovascular injury in the two groups. Conclusion:Both fluoroscopy and CT scan can obtain the mounting parameters of the Taylor Spatial Frame, and the results of correction of the peripheral deformities of the knee joint are satisfactory. However, CT measurement of the mounting parameters is more accurate which could achieve shorter operation time, and less times of electronic prescriptions.
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Objective:To compare the clinical effect of Ilizarov frame and unilateral frame in the treatment of tibial segmental bone defect combined with soft tissue defect by open bone transport.Methods:A retrospective case-control study was conducted to analyze the clinical data of 32 patients with tibial segmental bone defect and soft tissue defect-up who underwent open bone transport technique in Tianjin Hospital from August 2008 to August 2016 and obtained complete followed-up. There were 22 males and 10 females, aged 22-64 years (mean, 36.8 years). Nineteen patients in the Ilizarov group showed the mean bone defect length of 7.9 cm and mean soft tissue defect area of 41.4 cm 2. Thirteen patients in the unilateral group showed the mean bone defect length of 7.8 cm and the mean soft tissue defect area of 39.2 cm 2. The results of fracture healing, wound healing time, radiological consolidation index, external fixation index, Association for the Study and Application of the Method of Ilizarov (ASAMI) bone and lower-limb function score and incidence of complications were compared between the groups. Results:All patients were followed up for 24 to 60 months [(32.6±1.3)months]. Bone healing was achieved in all patients. The wound healing time was (2.7±2.3)days in Ilizarov group and (2.4±1.8)days in unilateral group ( P>0.05). The consolidation index was (43.4±8.7)d/cm in Ilizarov group and (45.8±10.3)d/cm in unilateral group ( P>0.05). The external fixation index was (52.6±8.9)d/cm in Ilizarov group and (58.7±12.9)d/cm in unilateral group ( P<0.05). The results of ASAMI bone score was excellent in 10 patients, good in 6, fair in 2 and poor in 1 in Ilizarov group, with the excellent rate of 84%; and excellent in 6 patients, good in 4, fair in 2, and poor in 1 in unilateral group, with the excellent rate of 77%, with insignificant difference between two groups ( P>0.05). The results of ASAMI lower-limb function score was excellent in 8 patients, good in 7, fair in 3, poor in 1 in Ilizarov group, with the excellent rate of 79%; and excellent in 6, good in 3, fair in 3, poor in 1 in unilateral group, with the excellent rate of 69%, with insignificant difference between the two groups ( P>0.05). Incidence of axial deviation was zero in Ilizarov group versus 23% in unilateral group ( P<0.05). After operation, Ilizarov group had refracture in 1 patient and pin site infection in 5, and unilateral group had refracture in 1 patient and pin site infection in 1, showing no significant difference between the two groups ( P>0.05). Conclusions:Tibial segmental bone defect with soft tissue defect can be effectively treated by open bone transport with Ilizarov and unilateral frame. Ilizarov frame has better biomechanical properties and is more convenient for correction of poor postoperative axial alignment.
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Objective To evaluate the clinical outcomes and correction accuracy of deformities around the knee joint using external fixator-assisted internal fixation (FAIF).Methods From January 2014 to March 2018,data of 15 patients (17 bone segments) with deformities around the knee joint who had been corrected with external fixator-assisted internal fixation were retrospectively analyzed.There were 6 males and 9 females,with an average age of 39 years (range,21-60 years).There were 9 patients with genu varus and 6 with genu valgus.All the 15 patients had shortening ranging from 5 to 22 mm,with an average of 12 mm.Unilateral external fixator was used to stabilize the osteotomy site intraoperatively until the satisfied mechanical axis was acquired.Then the plate or Intramedullary nail was inserted and fixed,the external fixator was removed after internal fixation.Results Femur osteotomy was done in 7 patients and tibia osteotomy was done in 6 patients,while 2 patients had osteotomy in both tibia and femur.Intramedullary nailing was used in 2 bone segments,and plate was used in 15 bone segments.The correction of angle ranged from 7° to 22°,with an average of 12.5°.The correction of the 9 cases of genua varus ranged from 10° to 22°,with an average of 17.6°.The correction of the 6 cases of genu valgum ranged from 7° to 13°,with an average of 10.4°.The mean time to achieve union of the osteotomy sites was 3.5 months (range,2.5-5.0 months).All the 15 patients were followed up for 8-48 months (average,23 months).The mechanical axis deviation (MAD) was 5.93 mm (range,0-15 mm) after operation which was 34.8 mm (range,8-55 mm) before operation.The mean post-operative mechanical lateral distal femoral angle (mLDFA) was 87.5° (range,84°-90°) which was 76.1° (range,66°-82°) before operation.The mean medial proximal tibia angle (MPTA) was 87.8° (range,86°-89°) which was 76.8° (range,68°-80°) before operation.There were no deep infection and neurovascular injury.Conclusion The FAIF not only has the advantage of minimal invasiveness and easy adjustment,but also can avoid uncomfortableness and complications of long-term of wearing the external fixator.It is an accurate and safe method to correct the deformities around the knee joint.
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Objective To investigate the clinical outcomes of combined Ilizarov technique with tendon transfer for the treatment of rigid equinovarus foot deformity.Methods A retrospective analysis was performed on the clinical data of 11 patients (14 feet) with rigid equinovarus foot deformity who were treated by Ilizarov technique combined with tendon transfer without additional bony procedures from August 2015 to February 2018.The average age was 21.6 years old (range,12-36 years old) and 6 patients were males and 5 patients were females.According to Dimeglio classification,8 feet were grade Ⅱ and 6 feet were grade Ⅲ.Seven patients (10 feet) were treated with external fixator and tendon transfer simultaneously.Four patients (4 feet) underwent staging surgery,in which Achilles tendon lengthening,plantar fascia lysis and slow correction of deformity with external fixator were performed as the first stage operation,followed by the second stage tendon transfer.The average interval between the two operations was 26.5 days (range,20-32 days).The lateral tibiotalar angle on load-bearing ankle radiographs and tibiocalcaneal angle on Saltzman view radiographs were measured after operation,and compared with that before operation.Functional evaluation was performed by The American Orthopaedic Foot and Ankle Society (AOFAS) and Ankle Hind foot Scale.Quality of life assessment was assessed by the MOS 36-Item Short Form Health Survey (SF-36) Scale.The excellent and good rate of operation was evaluated by the International Clubfoot Study Group (ICFSG) scoring system.Results All patients were followed up for 6 months to 36 months with an average of 20 months.All cases achieved effective correction.There were no neurovascular complications in this group of patients.The preoperative ankle range of motion in dorsiflexion was-19.9°± 14.8°,and plantar flexion 38.5°± 12.8°.At the latest follow-up,the mean dorsiflexion increased to 2.7°± 1.6° and the plantar flexion decreased to 21.0°±9.2°.Preoperative Dimeglio classification included 8 feet in grade Ⅱ,6 feet in grade Ⅲ.At the latest follow-up,there were 13 feet in grade Ⅰ and 1 foot in grade Ⅱ.The tibiotalar angle was 122.2°± 16.6° before surgery and 100.8°±4.8° at the latest follow-up.The tibiocalcaneal angle of the Saltzman view was-25.2°±9.2° before surgery and-3.7°±2.8° at the latest follow-up.The mean preoperative AOFAS score increased from 63.9± 12.7 to 85.2±9.7,with statistically significant difference (t=14.87,P＜ 0.05).The average SF-36 score increased from 50.1±8.4 to 63.7±8.1,with statistically significant difference (t=4.10,P＜ 0.05).At the latest follow-up,the average ICFSG score was 6.6 (range,3-16).According to the classification of ICFSG score,there were 7 feet excellent,6 feet good,and Ⅰ foot fair,with an excellent and good rate of 92.9％ (13/14).Conclusion Ilizarov technique combined with tendon transfer could achieve successful correction of rigid equinovarus foot deformity with satisfactory short-term results.
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Limb length discrepancy is caused by either congenital or acquired conditions,such as growth arrest,osteomyelitis,trauma or tumor.Conventional Limb lengthening utilizes external fixators which lead to great inconvenience to patient's daily life.Complications are however common including pin-site infection,soft tissue tethering from the pins and wires resulting in pain,regenerate deformity or fracture after frame removal and intolerance of the frames.In order to reduce the time of external fixator treatment,various combinations techniques of both external and internal fixation have been developed.However,there is still a risk of deep infection of the implant due to contamination of the previous pin tracts of the external fixation.Fullly implantable intramedullary lengthening nail can avoid the problems of external fixator,including discomfort,pin sites infection,muscular transfixation and soft tissue tethering.There are still some problems including serious pain,too quick lengthening and authorization,so the earlier generations of products could not be safely and widely used.The newest generation of magnetic intramedullary lengthening nail represented by PRECICE (NuVasive,Inc.,Irvine,CA,USA) has obtained good early clinical results with its stability,precision and controllability.PRECICE is broadly used in the world,which may become the new direction of treatment for limb lengthening and deformity correction.This article aims to review the recent development of fully implantable intramedullary lengthening nail,including clinical application,preoperative planning,key points of surgery,postoperative rehabilitation,and complications.
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Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot.Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed.There were 17 males and 4 females,aged from 26 to 65 years,with an average age of 43.9 years.The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm,and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months.The mean preoperative equinus contracture was-38.9° (range,-25° to-66°),and total ankle range of motion (ROM) was 7.1° (range,0°-18°).All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer.Two weeks after the flap transfer,distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot.The flap survival was observed in the postoperative period,and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up.The criteria were used to assess the morphological and functional outcome.Results A total of 21 resversed flaps were transferred,including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps.The sizes of flaps were from 7 cm±6 cm to 11 cm± 10 cm.Among them,17 patients underwent primary flap transfer,and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery.The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap.All 21 patients were followed up and the average periodof follow-up was 20.3 months (range,8-96 months).Among the 21 flaps,19 survived completely.Although marginal necrosis was observed in 2 cases,these wounds healed after subsequent debridement and dressing change treatment.No major complication was seen,but superficial pin tract infection was present in 4 cases who then received dressing change and oral antibiotic.Deformities were corrected,and ankle motion had increased significantly.The mean ankle activity at the latest follow up was 22° (range,8°-38°),and postoperative ICFSG score at the latest follow-up was 5.67±3.09,which significantly reduced compared with preoperative one (30.81 ±3.63).The difference was statistically significant (t=32.815,P=0.035).The results were excellent in 13 feet,good in 7,and fair in 1,with the excellent and good rate of 95.24％ (20/21).The local infections were cured without recurrence at operative site.Equinus deformities were corrected,and the latest follow-up results showed that all patients walked normally without recurrence.Conclusion Ilizarov method combined with reversed sural and saphenous neurocutaneous island flap can improve the limb function and the flap can survival with good clinical effect.
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Bone defects are usually resulted from traumatic injuries,infections,and bone tumors.The treatments mainly include autologous bone graft,allograft bone graft,distraction osteogenesis,vascularized bone grafting and amputation.All of the procedures show their inherent limitations due to different operative indications and different surgical techniques.The emergence of Masquelet technique provides a simple,safe,and more cost-effective solution in treating bone defects.The present article reviews the relevant literatures and summarizes the progress of Masquelet technique in the treatment of bone defects.The technique mainly includes two-step process which involves the induction of the induced membrane prior to the introduction of graft material into induced membrane.The first stage involves radical debridement of all infected or necrotic tissue,fracture stabilization,and filling the segmental bone defect with a cement spacer,composed of polymethyl methacrylate (PMMA) cement.Based on the results of culture performed on the wound samples,the sensitive antibiotics are mixed with cement for the infected bone defect.The second stage of bone grafting is performed within 6-8 weeks after the primary surgery.A longitudinal incision is performed through the induced membrane.The cement spacer is removed carefully and autogenous cancellous bone graft is placed to fill the bone defect and to close the induced membrane.A large number of experimental studies and clinical observations show that the induced membrane is a highly vascularized biological membrane rich in vascular endothelial growth factor (VEGF),transforming growth factor-β1(TGF-β1),bone morphogenetic protein 2 (BMP-2) and other growth factors,which can promote bone regeneration and repair.Masquelet technique can effectively treat multiple parts of posttraumatic bone defects,infectious bone defects,bone defects after tumor resection,congenital tibial pseudarthrosis,and so on.Masquelet provide a choice to treat bone defect for maxillofacial.The complications of Masquelet technique include infection recurrence,bone graft absorption,nonunion and pseudarthrosis.This study is to summarize the recent development of Masquelet technique,and to provide theoretical guidance for the application of Masquelet technique.
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Objective To compare the clinical effect of the treatment for calcaneal fracture by percutaneous reduction combined with Ilizarov stent and open reduction and internal fixation.Methods Data of 35 patients with closed calcaneal fractures from June 2012 to January 2014 were respectively analyzed.13 cases were fixed with poking reduction and Ilizarov support.Among them,there were 9 males and 4 females,aging from 20 to 51 years old (average,34.46± 10.21 years);Sanders type Ⅱ fractures in 2,type Ⅲ in 8 and type ⅣV in 3;Tscheme-Gotzen 2 degree of soft tissue injury in 9 and 3 degree in 4.22 cases were treated with open reduction and internal fixation.Among them,there were 15 males and 7 females,aging from 18 to 60 years old (average,33.59±12.07 years);Sanders type Ⅱ fractures in 3,type Ⅲ in 15,type ⅣV in 4;Tscheme-Gotzen 0 degree of soft tissue injury in 13 and 1 degree in 9.Results There was no significant difference in the anatomic parameters between the two groups before operation.Postoperative calcaneal B(o)hler angle of stent group (27.77°±2.86°) was less than that of the plate group (30.45°±3.45°),and Gissane angle of stent group (131.23°±3.92°) was larger than that of the plate group (127.82°±4.65°);axis angle of stent group (19.23°±2.20°) was less than that of the plate group (22.64°±5.14°);calcaneal width of stent group (33.61±3.43 mm) was less than plate group (36.05±3.26 mm),and the difference have statistical significance.The calcaneal length of the stent group (63.23±5.67 mm) was smaller than that in the plate group (63.59±4.58 mm),but there was no significant difference.The time from the injury to surgery in stent group (4.77±0.83 d) was less than that in the plate group (6.68± 1.84 d),the blood loss of stent group (45.00±6.04 ml) was significantly less than that of the plate group (292.95±43.66 ml).The fracture healing time of stent group (9.31± 1.38 week)was less than that of the steel plate group (9.82± 1.40 week),but there was no significant difference.About limb function American Orthopaedic Foot and Ankle Society (AOFAS) score,7 cases in the stent group were excellent,3 cases good,1 cases fair,2 cases poor;and 9 cases of the plate group were excellent,7 cases good,3 cases fair,3 cases poor,there was no significant difference.Conclusion For the Sanders Ⅱ / Ⅲ type calcaneal fractures and Sanders type ⅣV patients associated with soft tissue damage which are not suitable for open reduction and internal fixation in short term,Ilizarov technique is a good option.
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Objective To evaluate the clinical outcomes and correction accuracy of posttraumatic varus and valgus knee deformities using the Taylor Spatial Frame (TSF).Methods From June 2006 to December 2010,26 patients with posttraumatic varus and valgus knee deformities who had been treated with the TSF combined with less invasive high tibial osteotomy (HTO) or supracondylar femur osteotomy (SFO) were retrospectively analyzed,including 19 males and 7 females with an average age of 39 years.There were 20 cases of posttraumatic varus knees and 6 valgus knees.Twenty one patients were treated with HTO and 3 with SFO,2 with HTO and SFO simultaneously.During the operation,the TSF was firstly assembled and then the parameters of the frame were measured followed by less invasive percutaneous osteotomy.Correction was started seven to ten days after the operation following the time schedule provided by the computer program.Correction of the struts were performed 3 times per day,with a total movement of 0-3 mm.Results Through 7-35 days frame adjustments,20 cases of deformities were fully corrected.X-ray showed that the mechanical axis deviations of the tibia and femur all were recovered to normal range,and the deformity of rotation,angulation and crispation were fully corrected.Six cases had residual slight angulation or crispation deformity ( ＜ 4° or ＜ 10 mm).Through the second 4-10 days frame adjustments,these 6 cases of deformities were fully corrected finally.New bone formation and consolidation on the osteotomy site were good.The fixators were removed from 2.5-6.0 months after surgery and the appearance of the limbs and the patients' gait recovered to normal and the keen pain disappeared.All patients were followed up for 12-60 months and without the recurrence of the deformity.Eleven cases occured pin site infection and were controlled by use of the sensitive antibiotics.One case occured refracture of the distal femur osteotomy site 1.5 months after frame removal.Through conservative treatment,the fracture finally healed.Conclusion Posttraumatic varus and valgus knee deformities can be effectively corrected by using TSF and with a high accuracy.
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Objective To investigate the results and related key points in operative treatment of talar body fractures. Methods From April 2002 to July 2008, 44 patients with talar body fractures underwent the operation. There were 3 females and 41 males. The mean age of the patients was 31.7 years. The fractures occurred on the left side in 26 patients and on the right side in 18 patients. According to Sneppen classification, 24 type Ⅱ, 20 type V. Eleave cases were open fractures, according to the Gustilo-Anderson classification, there were 3 cases in type Ⅰ , 7 in type Ⅱ, 1 type in Ⅲ A. The mean interval between injury and surgical treatment for open fractures and close fractures was 5.3 hours and 8.9 days. The mechanism of injury was a fall from the height in 18 patients, a traffic accident in 13 patients, a crush injury in 8 patients, a sprain injury in 4 patients and a cut injury in 1 patient. Anteromedial approach was used for 15 close fractures, anterolateral approach for 3 and combined anteromedial-anterolateral approach for 15. K-wires fixation were utilized for 3 fractures, screws and temporary K-wires fixation for 5 cases, bioabsorbable screws for 2fractures, cannulated screws for 30 fractures and cannulated screws and threaded cancellous screws for 4cases. Results Thirty-five patients were followed up 21 to 89 months (average, 44.5 months). Necrosis of incision was found in 4 cases, wound infection occurred in 1 case. All fractures had achieved bone union;the average healing time was 22 weeks. Functional results were assessed according to AOFAS score, the average score was 77.3, There were 11 patients in excellent results, 13 in good, 10 in fair and 1 in poor. The overall excellent and good rate was 68.6%. Avascular necrosis occurred in 5 cases. Traumatic arthritis occurred in 19 cases. Arthrodesis was needed in 5 cases. Conclusion The timing and approach of surgery is determined by the condition of the talar fractures and soft tissue. Anatomical reduction, preservation of the blood supply and early active pain-free mobilization are key points in the treatment of the talar body fractures.
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Objective To introduce the treatment of intraarticular calcaneal fractures with poor soft tissue using poking reduction combined with Ilizarov methods. Methods From September 2007 to September 2009,11 patients with the intraarticular calcaneal fractures were treated with poking reduction combined with Ilizarov methods,including 10 males and 1 female at average age of 33.6 years(range,21-50 years).Four patients had the left calcaneal fractures and seven with the right ones.According to Sander classification,there were seven patients with type II fractures,three with type III fractures and one with type IV fracture.The various extents of heel soft tissue injury were emerged in all the patients.Before operation,B(o)hler angle was 0°-12°(average 8°)and Gissane angle 70°-95°(average 80°).According to AO classification of close soft tissue injury,there were three patients with type IC2,six with type IC3,one with type IC5 and one with open soft tissue injury.The collapse of the articular surface was recovered by Steinmann pin which passed through the lateral calcaneal tubercle.The medial and lateral fracture fragments were corrected by using the tensed olive wires.The heighat and width were maintained by using the Ilizarov external fixation. Results The mean duration of follow-up was 13.3 months (range,6-20 months).All fractures were healed after mean duration for 8.1 weeks(range,7-10weeks).The postoperative B(o)hler angle was 20°-45°(average 33°)and Gissane angle 100°-118°(average 107°).According to Maryland Foot Score system,the result of postoperative function was excellent in seven patients,good in three and fair in one,with excellence rate of 91%. Conclusions For the intraarticular calcaneal fractures,the poking reduction combined with Ilizarov method is able to recover and maintain the normal calcaneal height and width and reduce postoperative wound infections and many other complications.specially for Sanders II or III with severe soft tissue injury in the open or closed calcaneal fractures.Master of surgical indications and operating poims can attain satisfactory clinical efficacy.
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[Objective]To observe the clinical effects and the comments of the circular external fixator on the treatment of spiral and oblique fractures of distal one-third of tibia-fibular.[Method]Fifteen patients(11 males,4 females),with a mean age of 38.5 years(range 21 to 57)with spiral and oblique fractures of distal 1/3 of tibia-fibular were treated with circular external fixator from August 2005 to October 2008.The aetiologies of the fractures were as follows:8 cases,motor vehicle accident;5 cases,falls;2 cases,crush.All the fractures were closed.Nine cases had skin and soft tissue contusion on the distal leg and ankle.[Result]All patients were followed up and acquired the bony union.The mean follow-up time was 10.5 months(range 6～30 months).The mean framing time was 4.5 months(range 2.5～9 months).None of the patients had soft tissues infection and osteomyelitis.None of the patients suffered from the complications such as shortness,angulation,rotation deformity.None of the patients suffered from refracture after removal of the frame.Three patients had pin tract infection and were treated by oral antibiotics.Four patients had loss of range of motion in the ankle after the removal of the frame.These 4 patients had loss of mean 5-degree dorsiflexion and mean 10-degree plantar-flexion.All the patients had full knee function.[Conclusion]The circular external fixator may be used as an alternative method in the treatment of spiral and oblique fractures of distal 1/3 of tibia-fibular and the patients can avoid suffering from the removal of internal fixators.
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[Objective]To investigate the clinic application of the reversed sural neurocutaneous island flap in repairing the soft tissue defect of the foot and ankle.[Method]From June 1997 to December 2007,38 cases of the lower leg,around the ankle and the heel soft tissue defects were treated with the reversed sural neurocutaneous island flap.The average of the patients was 38.3 years(range 5 to 65).The longest medical history was 11 years.The lagest area of flap was 17 cm?12 cm and the smallest was 5 cm?4 cm.[Result]Thirty-three flaps were completely survived,there were 5 cases with distal edge of the flaps partially necrosis and healed after short time dressing change.The patients were followed up for half a year to 10 years and the curative effect was satisfactory.[Conclusion]The reversed sural neurocutaneous flap is simple to harvest and its blood supply is reliable without the sacrifice of a major blood vessel.So it is an ideal method for repairing the soft tissue defect of the foot and ankle.
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[Objective]To observe the clinical effect of proximal humeral fractures treated with locking proximal humerus plate.[Method]From April 2004 to August 2008,21 patients with proximal humeral fractures were all treated with locking proximal humerus plates,the average age of the patients was 51 years(range 35-78).According to Neer classification:two-part fracture 7,three-part fracture 12,four-part fracture 2.[Result]Twenty-one patients were all followed up for 6-24 months(average 14 months),all fractures occurred bony union.Clinical effect was evaluated by Neer functional assessment system:excellent 14,good 5,fare 2.[Conclusion]Application of locking proximal humerus plates in treating proximal humeral fractures can obtain satisfactory therapeutic result and is a more ideal method of internal fixation of proximal humeral fractures at present,attaching importance to injury of shoulder sleeve and early exercise,most patients can acquire satisfactory clinical effect.
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[Objective]To investigate the clinical effects of Ilizarov external fixator combined pedicle flaps transfer on the treatment of infective fracture nonunion with soft tissue defects in legs.[Method]Fiftecn patients aged 20-58 years(mean age 40 years) were treated with Ilizarov external fixator combined pedicle flaps transfer from July 2005 to September 2008.The areas of flaps were 6 cm?5 cm-15 cm?10 cm.[Result]All patients were followed up.The mean follow-up time was 13 months(range 8-33 months).Fourteen patients achieved fracture union.One patient had partial flap necrosis and recurrent infection and healed aafter a repeat operation.The average tibia fracture healing time was 6.5 months.The mean framing time was 7.0 months.[Conclusion]Ilizarov external fixator combined pedicle flaps transfer can effectively treat infective fractures nonunion with soft tissue defects in legs.In order to achieve the desired results,proper surgery timing and surgical indications are important.