STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUZhong , XUHong , ZHANGZhao , WUMeng ,  TENGYunsheng , TAOShenglin

Department of Traumatic Orthopedics, Xi'an Ordnance Industrial 521. st Hospital, Xi'an Shaanxi, 710065, P. R. China;

Corresponding author：

TENGYunsheng, Email: csgk521@126.com

Keywords：

Antibiotic-loaded cement; Fibular graft; Bone defect; Staged treatment

DOI：

10.7507/1002-1892.20140263

Video：

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Objective To explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity. Methods A retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases. Results All wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up. Conclusion Infection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.

Citation： LIUZhong, XUHong, ZHANGZhao, WUMeng, TENGYunsheng, TAOShenglin. STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1212-1216. doi: 10.7507/1002-1892.20140263 Copy

1.	Bishop AT, Pelzer M.Vascularized bone allotransplantation:current state and implications for future reconstructive surgery.Orthop Clin North Am, 2007, 38(7):109-122, vii.
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3.	Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
4.	Lasaniano NG, Kanakaris NK, Giannoudis PV.Current management of long-bone large segmental defects.Orthop Trauma, 2010, 24(2):149-163.
5.	滕云升, 刘重, 智丰, 等.腓骨骨皮瓣组合股前外侧皮瓣修复小腿复合组织缺损.中华显微外科杂志, 2009, 32(2):116-118.
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7.	Zunino JH, Bengochea M, Johnston J, et al.Immunologic and osteogeneic properties of xenogeneic and allogeneic demineralized bone transplants.Cell Tissue Bank, 2004, 5(3):141-148.
8.	Korompilias AV, Paschos NK, Lykissas MG, et al.Recent updates of surgical techniques and applications of free vascularized fibular graft in extremity and trunk reconstruction.Microsurgery, 2011, 31(3):171-175.
9.	Girard PJ, Kuhn KM, Bailey JR, et al.Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects:a report of two cases.J Orthop Trauma, 2013, 27(9):220-226.
10.	Buchholz HW, Elson RA, Engelbrecht E, et al.Management of deep infection of total hip replacement.J Bone Joint Surg (Br), 1981, 63-B (3):342-353.
11.	刘相成, 周勇刚, 王岩, 等.自制关节型抗生素骨水泥占位器在人工髋关节置换术后感染二期翻修中的应用.中华外科杂志, 2010, 48(14):1050-1054.
12.	Zuluaga AF, Galvis W, Saldarriaga JG, et al.Etiologic diagnosis of chronic osteomyelitis:a prospective study.Ar Intern Med, 2006, 166(1):95-100.
13.	Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
14.	Giannoudis PV, Faour O, Goff T, et al.Masquelet technique for the treatment of bone defects:tips-tricks and future directions.Injury, 2011, 42(6):591-598.
15.	杨运发, 张光明, 徐中和.下肢创伤后大段感染性骨缺损的分型及修复.中华创伤骨科杂志, 2010, 12(5):417-420.
16.	Van der Veen FJC, Strackee SD, Besselaar PP.Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children.Treatment with osteotomy and synostosis at one session.J Orthop, 2014, 62(12):48-53.
17.	Makridis KG, Theocharakis S, Fragkakis EM, et al.Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report.Foot Ankle Surg, 2013, 20(2):19-22.
18.	滕云升, 王兆杰, 刘重, 等.游离腓骨皮瓣修复前足复合组织缺损.中国修复重建外科杂志, 2013, 27(3):378-379.

1. Bishop AT, Pelzer M.Vascularized bone allotransplantation:current state and implications for future reconstructive surgery.Orthop Clin North Am, 2007, 38(7):109-122, vii.
2. Aronson J.Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method.J Bone Joint Surg (Am), 1997, 79(8):1243-1258.
3. Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
4. Lasaniano NG, Kanakaris NK, Giannoudis PV.Current management of long-bone large segmental defects.Orthop Trauma, 2010, 24(2):149-163.
5. 滕云升, 刘重, 智丰, 等.腓骨骨皮瓣组合股前外侧皮瓣修复小腿复合组织缺损.中华显微外科杂志, 2009, 32(2):116-118.
6. 赵刚, 齐明, 张伯松, 等.慢性骨髓炎的分期治疗策略.中国骨与关节外科, 2012, 5(5):416-419.
7. Zunino JH, Bengochea M, Johnston J, et al.Immunologic and osteogeneic properties of xenogeneic and allogeneic demineralized bone transplants.Cell Tissue Bank, 2004, 5(3):141-148.
8. Korompilias AV, Paschos NK, Lykissas MG, et al.Recent updates of surgical techniques and applications of free vascularized fibular graft in extremity and trunk reconstruction.Microsurgery, 2011, 31(3):171-175.
9. Girard PJ, Kuhn KM, Bailey JR, et al.Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects:a report of two cases.J Orthop Trauma, 2013, 27(9):220-226.
10. Buchholz HW, Elson RA, Engelbrecht E, et al.Management of deep infection of total hip replacement.J Bone Joint Surg (Br), 1981, 63-B (3):342-353.
11. 刘相成, 周勇刚, 王岩, 等.自制关节型抗生素骨水泥占位器在人工髋关节置换术后感染二期翻修中的应用.中华外科杂志, 2010, 48(14):1050-1054.
12. Zuluaga AF, Galvis W, Saldarriaga JG, et al.Etiologic diagnosis of chronic osteomyelitis:a prospective study.Ar Intern Med, 2006, 166(1):95-100.
13. Pattyn C, De Geest T, Ackerman P, et al.Preformed gentamicin spacers in two-stage revision hip arthroplasty:functional results and complication.Int Orthop, 2011, 35(10):1471-1476.
14. Giannoudis PV, Faour O, Goff T, et al.Masquelet technique for the treatment of bone defects:tips-tricks and future directions.Injury, 2011, 42(6):591-598.
15. 杨运发, 张光明, 徐中和.下肢创伤后大段感染性骨缺损的分型及修复.中华创伤骨科杂志, 2010, 12(5):417-420.
16. Van der Veen FJC, Strackee SD, Besselaar PP.Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children.Treatment with osteotomy and synostosis at one session.J Orthop, 2014, 62(12):48-53.
17. Makridis KG, Theocharakis S, Fragkakis EM, et al.Reconstruction of an extensive soft tissue and bone defect of the first metatarsal with the use of Masquelet technique:a case report.Foot Ankle Surg, 2013, 20(2):19-22.
18. 滕云升, 王兆杰, 刘重, 等.游离腓骨皮瓣修复前足复合组织缺损.中国修复重建外科杂志, 2013, 27(3):378-379.

Chinese Journal of Reparative and Reconstructive Surgery

STAGED TREATMENT OF INFECTIOUS LONG BONE DEFECT IN LOWER EXTREMITY

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