Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial.

OBJECTIVES: To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects. DESIGN: Prospective, randomized, controlled study. SETTING: Tertiary-level center. PARTICIPANTS: Thirty patients with infected nonunited long-bone fractures of lower limbs were included. INTERVENTION: Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B. OUTCOME MEASUREMENTS: The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification. RESULTS: The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index ( P value 0.08). CONCLUSIONS: This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Bifocal Compression-Distraction for Combined Bone and Soft-Tissue Defects in Post-traumatic Tibial Nonunion.

OBJECTIVE: To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. DESIGN: Nonrandomized prospective, case series, single-center study. SETTING: Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt. PARTICIPANTS: Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. INTERVENTION: Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique. OUTCOME MEASUREMENTS: The external fixation index (EFI); functional and bone results; and complication rates. RESULTS: All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups. CONCLUSIONS: Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Femoral and Dega osteotomies in the treatment of habitual hip dislocation in Down syndrome patients - is it efficient or not?

PURPOSE: The purpose of this case series study is to report on the intermediate-term outcomes following a femoral varus derotational osteotomy (FVDO) performed in conjunction with a Dega osteotomy (DO) in management of hip -instability in Down syndrome (DS) patients. METHODS: Ten hips in seven children with DS suffering from hip dislocation were included. All patients included in this study had hip dislocation in the habitual phase and painless mobile hip to full abduction. All patients were firstly subjected to FVDO. An additional DO was added if intraoperative assessment demonstrated posterior instability. The mean age at time of surgery was 5.6 years (3 to 7). There were three male and four female patients. All patients were followed up after two years with a mean follow-up of 3.27 years (2 to 5). All operations were performed by the first author. RESULTS: There was improvement of neck shaft angles (130° to 175°, median = 160° preoperatively, to 120° to 140°, median =130° postoperatively). The Shenton line was restored in all our cases. There was also improved percentage of the femoral head uncovered by the lateral wall of the acetabulum (25° to 100° with median = 45° preoperatively, to 0° to 15° with median = 5° postoperatively) and improved posterior acetabular coverage, which was assessed by CT. CONCLUSION: FVDO combined with DO without -capsulorrhaphy is efficient in the management of hip instability in DS, as it corrects hip biomechanics and increases posterior acetabular coverage. LEVEL OF EVIDENCE: IV - retrospective case series.