One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaohui ,  GAO Junqing , ZHAN Xiaohuan , HUANG Zhaohua , ZHANG Jiasheng

Department of Reparative and Reconstructive Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, 528000, P.R.China;

Corresponding author：

GAO Junqing, Email: gao-7950@163.com

Keywords：

Lateral malleolus defect; debridement; Ilizarov bone transport technology; fibula osteotomy

DOI：

10.7507/1002-1892.201901091

Video：

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Objective To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.

Citation： WANG Zhaohui, GAO Junqing, ZHAN Xiaohuan, HUANG Zhaohua, ZHANG Jiasheng. One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 865-870. doi: 10.7507/1002-1892.201901091 Copy

1.	Debnath UK, Maripuri SN, Guha AR, et al. Open grade Ⅲ " floating ankle” injuries: a report of eight cases with review of literature. Arch Orthop Trauma Surg, 2007, 127(8): 625-631.
2.	杜全红, 史永安, 丛海波, 等. 游离髂骨移植重建外踝的临床研究. 中华创伤骨科杂志, 2016, 18(6): 493-497.
3.	胡沣, 赵光勋, 方健, 等. 带蒂腓骨头瓣联合腓浅神经营养皮瓣修复儿童外踝骨及软组织缺损. 中华显微外科杂志, 2017, 40(2): 139-141.
4.	任义军, 严立, 胡锐, 等. Ilizarov技术在治疗胫骨骨与软组织缺损中的应用. 中华创伤骨科杂志, 2017, 19(3): 213-218.
5.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot ankle Int, 1994, 15(7): 349-353.
6.	Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, et al. Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res, 2005, (437): 209-218.
7.	韦健, 容安, 周建飞, 等. 腓骨延长术治疗外踝开放性骨缺损. 中医正骨, 2016, 28(10): 62-63.
8.	俞立新, 高建明, 吴水培, 等. 带血管蒂第二跖骨底骨瓣移位修复外踝骨缺损. 中国修复重建外科杂志, 2002, 16(2): 117-119.
9.	武勇, 赖良鹏, 王岩, 等. 全踝关节置换治疗终末期踝关节炎疗效分析. 中华骨科杂志, 2015, 35(7): 699-706.
10.	詹晓欢, 陈元荣, 罗桦杰, 等. Gustilo ⅢB和ⅢC型骨折治疗进展. 中华显微外科杂志, 2018, 41(3): 310-312.
11.	Laible C, Earl-Royal E, Davidovitch R, et al. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem? J Orthop Trauma, 2012, 26(2): 92-97.
12.	秦泗河, 焦绍锋, 潘奇. Ilizarov技术结合游离皮瓣移植治疗创伤后重度马蹄足畸形伴跟骨缺损一例. 中华创伤骨科杂志, 2013, 15(10): 919-920.
13.	张磊, 王新卫, 陈雨声, 等. 应用Ilizarov技术治疗骨髓炎出现复杂软组织问题的处理技巧探讨. 中国修复重建外科杂志, 2018, 32(10): 1286-1291.
14.	尚大财, 刘钦林, 钟生财, 等. Ilizarov骨滑移技术治疗四肢长骨创伤性骨髓炎的临床研究. 中国矫形外科杂志, 2016, 24(3): 220-225.
15.	高堪达, 王秋根, 黄建华, 等. 骨搬运技术在下肢创伤后感染性骨缺损治疗中的应用. 中华创伤骨科杂志, 2009, 11(10): 985-987.
16.	邹宇炜, 杨新明, 苏峰, 等. 外踝长度短缩时踝关节应力改变的研究. 中国临床解剖学杂志, 2005, 23(6): 661-663.
17.	Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury, 2010, 41(2): 128-132.
18.	滕星, 黄雷, 杨胜松, 等. 应用混合式外固定支架骨搬运技术治疗胫骨干骺端骨缺损. 中华创伤骨科杂志, 2013, 15(10): 834-839.
19.	Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma, 2003, 17(7): 503-507.
20.	Britten S, Ghoz A, Duffield B, et al. Ilizarov fixator pin site care: the role of crusts in the prevention of infection. Injury, 2013, 44(10): 1275-1278.
21.	成亮, 徐佳, 柴益民, 等. 单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较. 中华创伤骨科杂志, 2015, 17(10): 863-867.

1. Debnath UK, Maripuri SN, Guha AR, et al. Open grade Ⅲ " floating ankle” injuries: a report of eight cases with review of literature. Arch Orthop Trauma Surg, 2007, 127(8): 625-631.
2. 杜全红, 史永安, 丛海波, 等. 游离髂骨移植重建外踝的临床研究. 中华创伤骨科杂志, 2016, 18(6): 493-497.
3. 胡沣, 赵光勋, 方健, 等. 带蒂腓骨头瓣联合腓浅神经营养皮瓣修复儿童外踝骨及软组织缺损. 中华显微外科杂志, 2017, 40(2): 139-141.
4. 任义军, 严立, 胡锐, 等. Ilizarov技术在治疗胫骨骨与软组织缺损中的应用. 中华创伤骨科杂志, 2017, 19(3): 213-218.
5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot ankle Int, 1994, 15(7): 349-353.
6. Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, et al. Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res, 2005, (437): 209-218.
7. 韦健, 容安, 周建飞, 等. 腓骨延长术治疗外踝开放性骨缺损. 中医正骨, 2016, 28(10): 62-63.
8. 俞立新, 高建明, 吴水培, 等. 带血管蒂第二跖骨底骨瓣移位修复外踝骨缺损. 中国修复重建外科杂志, 2002, 16(2): 117-119.
9. 武勇, 赖良鹏, 王岩, 等. 全踝关节置换治疗终末期踝关节炎疗效分析. 中华骨科杂志, 2015, 35(7): 699-706.
10. 詹晓欢, 陈元荣, 罗桦杰, 等. Gustilo ⅢB和ⅢC型骨折治疗进展. 中华显微外科杂志, 2018, 41(3): 310-312.
11. Laible C, Earl-Royal E, Davidovitch R, et al. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem? J Orthop Trauma, 2012, 26(2): 92-97.
12. 秦泗河, 焦绍锋, 潘奇. Ilizarov技术结合游离皮瓣移植治疗创伤后重度马蹄足畸形伴跟骨缺损一例. 中华创伤骨科杂志, 2013, 15(10): 919-920.
13. 张磊, 王新卫, 陈雨声, 等. 应用Ilizarov技术治疗骨髓炎出现复杂软组织问题的处理技巧探讨. 中国修复重建外科杂志, 2018, 32(10): 1286-1291.
14. 尚大财, 刘钦林, 钟生财, 等. Ilizarov骨滑移技术治疗四肢长骨创伤性骨髓炎的临床研究. 中国矫形外科杂志, 2016, 24(3): 220-225.
15. 高堪达, 王秋根, 黄建华, 等. 骨搬运技术在下肢创伤后感染性骨缺损治疗中的应用. 中华创伤骨科杂志, 2009, 11(10): 985-987.
16. 邹宇炜, 杨新明, 苏峰, 等. 外踝长度短缩时踝关节应力改变的研究. 中国临床解剖学杂志, 2005, 23(6): 661-663.
17. Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury, 2010, 41(2): 128-132.
18. 滕星, 黄雷, 杨胜松, 等. 应用混合式外固定支架骨搬运技术治疗胫骨干骺端骨缺损. 中华创伤骨科杂志, 2013, 15(10): 834-839.
19. Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma, 2003, 17(7): 503-507.
20. Britten S, Ghoz A, Duffield B, et al. Ilizarov fixator pin site care: the role of crusts in the prevention of infection. Injury, 2013, 44(10): 1275-1278.
21. 成亮, 徐佳, 柴益民, 等. 单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较. 中华创伤骨科杂志, 2015, 17(10): 863-867.

Chinese Journal of Reparative and Reconstructive Surgery

One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect

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