Open AccessMethods to shorten the duration of an external fixator in the management of tibial infections
Author(s) -
Khaled Emara,
Khaled Abd Al Ghafar,
M. Adnane
Publication year - 2011
Publication title -
world journal of orthopedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.76
H-Index - 43
ISSN - 2218-5836
DOI - 10.5312/wjo.v2.i9.85
Subject(s) - medicine , external fixation , intramedullary rod , distraction , distraction osteogenesis , osteomyelitis , bone grafting , ilizarov technique , surgery , orthopedic surgery , external fixator , soft tissue , bone healing , fixation (population genetics) , population , environmental health , neuroscience , biology
Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening condition. The only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis; yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss, is the long duration of the fixator. In addition to autologous bone grafting, several mechanical, biologic, and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis patients. Mechanical approaches include compressive loading of the distraction regenerate, increased frequency of small increments of distraction, and compression-distraction. Intramedullary nailing and hemicorticotomy can reduce the time in external fixation; however, these techniques are associated with technical difficulties and complications. Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation. Other promising modalities include diphosphonates, physician-directed use (off-label use) of bone morphogenetic proteins, and local injection of bone marrow aspirate and platelet gel at the osteotomy site. Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer.