EFFECTIVENESS OF Ilizarov TECHNOLOGY FOR INFECTED FOREARM NONUNION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHUYanfeng ¹ , PANZijie ² , CUIXiang ³ , QUANChenliang ³ , WANGJunsong ³ , ZHANGWei ³ , ZHANGZhuo ³ ,  ZHANGQun ³

1. No.2 Department of Orthopaedics, Hospital of Hebei Province Traditional Chinese Medicine (Hospital Affiliated to Hebei College of Traditional Chinese Medicine), Shijiazhuang Hebei, 050011, P.R.China;
2. Department of Surgery, No.522 Hospital of Chinese PLA;
3. Department of Orthopedics, General Hospital of Chinese PLA;

Corresponding author：

ZHANGQun, Email: zhangqun301@sina.com

Keywords：

Infected nonunion; Forearm; Distraction osteogenesis; Bone lengthening

DOI：

10.7507/1002-1892.20160302

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Objective To explore the effectiveness and method of Ilizarov technology for the treatment of infected forearm nonunion. Methods Between January 2004 and March 2014, 19 patients with infected forearm nonunion were treated, including 12 males and 7 females with a mean age of 37.4 years (range, 18-62 years). The injury causes included traffic accident in 11 patients, falling from height in 4 patients, and machine twist injury in 4 patients. The patients had received surgical treatment for 1-5 times (mean, 2.7 times). Bone defects located at the radius in 10 cases, at the ulna in 7 cases, and at the radius and ulna in 2 cases. The mean time of chronic infection was 8.3 months (range, 4-16 months). The mean length of the bone defects after debridement was 3.54 cm (range, 2.2-7.5 cm). Under the guidance of C-arm fluoroscope, the Orthofix unilateral external fixator was used to fix. Distraction was performed at 7-10 days after operation, and X-ray film was taken regularly to detect the osteogenesis. Results The mean external fixation time was 6.5 months (range, 3-12 months), and the mean external fixation index was 1.72 months/cm (range, 1.14-2.15 months/cm). All patients were followed up for 35.4 months on average (range, 24-55 months). The bone union time was 3-11 months (mean, 6 months); and no recurrence of infection was observed. At last follow-up, the mean wrist range of motion (ROM) were 52.78° (range, 42-55°) in flexion and 46.53° (range, 40-60°) in extension; the mean elbow ROM were 139.23° (range, 130-150°) in flexion and 3.57° (range, 0-20°) in extension; and the mean forearm ROM were 76.68° (range, 68-90°) in pronation and 81.75° (range, 72-90°) in supination. Conclusion Ilizarov technology for infected forearm nonunion can acquire satisfactory clinical results. Radical debridement is the key to control bone infection.

Citation： ZHUYanfeng, PANZijie, CUIXiang, QUANChenliang, WANGJunsong, ZHANGWei, ZHANGZhuo, ZHANGQun. EFFECTIVENESS OF Ilizarov TECHNOLOGY FOR INFECTED FOREARM NONUNION. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(12): 1457-1461. doi: 10.7507/1002-1892.20160302 Copy

1.	Prasarn ML, Ouellette EA, Miller DR. Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg, 2010, 130(7):867-873.
2.	Ring D, Allende C, Jafarnia K, et al. Ununited diaphyseal forearm fractures with segmental defects:plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg (Am), 2004, 86-A (11):2440-2445.
3.	Liu T, Liu Z, Ling L, et al. Infected forearm nonunion treated by bone transport after debridement. BMC Musculoskelet Disord, 2013, 14:273.
4.	El-mowafi H, Elalfi B, Wasfi K. Functional outcome following treatment of segmental skeletal defects of the forearm bones by Ilizarov application. Acta Orthop Belg, 2005, 71(2):157-162.
5.	dos Reis FB, Faloppa F, Fernandes HJ, et al. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann Surg Innov Res, 2009, 3:5.
6.	Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg, 2013, 71(5):503-509.
7.	Malki A, Wong-Chung J, Hariharan V. Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure. Injury, 2000, 31(5):345-349.
8.	Omololu B, Ogunlade SO, Alonge TO. Limb conservation using non vascularised fibular grafts. West Afr J Med, 2002, 21(4):347-349.
9.	Stevanovic M, Gutow AP, Sharpe F. The management of bone defects of the forearm after trauma. Hand Clin, 1999, 15(2):299-318.
10.	Steinlechner CW, Mkandawire NC. Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg (Br), 2005, 87(9):1259-1263.
11.	Han CS, Wood MB, Bishop AT, et al. Vascularized bone transfer. J Bone Joint Surg (Am), 1992, 74(10):1441-1449.
12.	Eralp L, Kocaoglu M, Rashid H. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. Surgical technique. J Bone Joint Surg (Am), 2007, 89(Suppl 2 Pt2):183-195.
13.	Arai K, Toh S, Yasumura M, et al. One-bone forearm formation using vascularized fibula graft for massive bone defect of the forearm with infection:case report. J Reconstr Microsurg, 2001, 17(3):151-155.
14.	Zhang X, Liu T, Li Z, et al. Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur. J Bone Joint Surg (Br), 2007, 89(11):1509-1514.
15.	Yajima H, Tamai S, Mizumoto S, et al. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res, 1993, (293):256-264.
16.	Minami A, Kasashima T, Iwasaki N, et al. Vascularised fibular grafts. An experience of 102 patients. J Bone Joint Surg (Br), 2000, 82(7):1022-1025.
17.	Gore DR, Gardner GM, Sepic SB, et al. Function following partial fibulectomy. Clin Orthop Relat Res, 1987, (220):206-210.
18.	González-Herranz P, del Río A, Burgos J, et al. Valgus deformity after fibular resection in children. J Pediatr Orthop, 2003, 23(1):55-59.
19.	Maini L, Chadha M, Vishwanath J, et al. The Ilizarov method in infected nonunion of fractures. Injury, 2000, 31(7):509-517.
20.	Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined Ilizarov/Taylor Spatial Frame technique. J Orthop Trauma, 2011, 25(3):162-168.
21.	Megas P, Saridis A, Kouzelis A, et al. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury, 2010, 41(3):294-299.
22.	Krishnan A, Pamecha C, Patwa JJ. Modified Ilizarov technique for infected nonunion of the femur:the principle of distraction-compression osteogenesis. J Orthop Surg (Hong Kong), 2006, 14(3):265-272.

1. Prasarn ML, Ouellette EA, Miller DR. Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg, 2010, 130(7):867-873.
2. Ring D, Allende C, Jafarnia K, et al. Ununited diaphyseal forearm fractures with segmental defects:plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg (Am), 2004, 86-A (11):2440-2445.
3. Liu T, Liu Z, Ling L, et al. Infected forearm nonunion treated by bone transport after debridement. BMC Musculoskelet Disord, 2013, 14:273.
4. El-mowafi H, Elalfi B, Wasfi K. Functional outcome following treatment of segmental skeletal defects of the forearm bones by Ilizarov application. Acta Orthop Belg, 2005, 71(2):157-162.
5. dos Reis FB, Faloppa F, Fernandes HJ, et al. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann Surg Innov Res, 2009, 3:5.
6. Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg, 2013, 71(5):503-509.
7. Malki A, Wong-Chung J, Hariharan V. Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure. Injury, 2000, 31(5):345-349.
8. Omololu B, Ogunlade SO, Alonge TO. Limb conservation using non vascularised fibular grafts. West Afr J Med, 2002, 21(4):347-349.
9. Stevanovic M, Gutow AP, Sharpe F. The management of bone defects of the forearm after trauma. Hand Clin, 1999, 15(2):299-318.
10. Steinlechner CW, Mkandawire NC. Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg (Br), 2005, 87(9):1259-1263.
11. Han CS, Wood MB, Bishop AT, et al. Vascularized bone transfer. J Bone Joint Surg (Am), 1992, 74(10):1441-1449.
12. Eralp L, Kocaoglu M, Rashid H. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. Surgical technique. J Bone Joint Surg (Am), 2007, 89(Suppl 2 Pt2):183-195.
13. Arai K, Toh S, Yasumura M, et al. One-bone forearm formation using vascularized fibula graft for massive bone defect of the forearm with infection:case report. J Reconstr Microsurg, 2001, 17(3):151-155.
14. Zhang X, Liu T, Li Z, et al. Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur. J Bone Joint Surg (Br), 2007, 89(11):1509-1514.
15. Yajima H, Tamai S, Mizumoto S, et al. Vascularized fibular grafts in the treatment of osteomyelitis and infected nonunion. Clin Orthop Relat Res, 1993, (293):256-264.
16. Minami A, Kasashima T, Iwasaki N, et al. Vascularised fibular grafts. An experience of 102 patients. J Bone Joint Surg (Br), 2000, 82(7):1022-1025.
17. Gore DR, Gardner GM, Sepic SB, et al. Function following partial fibulectomy. Clin Orthop Relat Res, 1987, (220):206-210.
18. González-Herranz P, del Río A, Burgos J, et al. Valgus deformity after fibular resection in children. J Pediatr Orthop, 2003, 23(1):55-59.
19. Maini L, Chadha M, Vishwanath J, et al. The Ilizarov method in infected nonunion of fractures. Injury, 2000, 31(7):509-517.
20. Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined Ilizarov/Taylor Spatial Frame technique. J Orthop Trauma, 2011, 25(3):162-168.
21. Megas P, Saridis A, Kouzelis A, et al. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury, 2010, 41(3):294-299.
22. Krishnan A, Pamecha C, Patwa JJ. Modified Ilizarov technique for infected nonunion of the femur:the principle of distraction-compression osteogenesis. J Orthop Surg (Hong Kong), 2006, 14(3):265-272.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF Ilizarov TECHNOLOGY FOR INFECTED FOREARM NONUNION

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