1, Istanbul Medical Faculty, Department of Orthopedics and Traumatology, Istanbul

2 Medicana Hospital, Department of Orthopedics and Traumatology, Samsun

3 Ortopedia Hospital, Department of Orthopedics and Traumatology, Adana

4 Memorial Hospital Sisli, Department of Orthopedics and Traumatology, Istanbul

09.08.2013 1

Limb Lengthening and Reconstruction Society 23th Annual Scientific Meeting

New York

Balci Halil1, , Eralp Levent1, , Sen Cengiz1, , Tomak Yılmaz2,Gülsen Mahir3, Celiktas Mustafa3, Dikmen Goksel 1, Bas Ali 1, Kocaoglu Mehmet4, , Kapıcıoglu Mehmet 1 Cakmak Mehmet 1

Comparison of two defect reconstruction techniques following osteomyelitic bone segment debridement of

the femur

All Authors

We have no potential conflicts

with this presentation.

8/9/2013 2

• Need debridment with segmental resection that results in long bone defects

• Reconstruction of the defects depends both on the surgeon preference and local anatomic characteristics

The Femur Cierny Mader Type 4 Osteomyelitis

Problems

• Bone segment loss

• Soft tissue loss

• Leg-length discrepancy

• Deformity

ACUTE COMPRESSION AND DISTRACTION (ACD)

SEGMENT TRANSPORT (ST)

PATIENTS & METHODS

• 48 femur osteomyelitis

• Multicenter study conducted by Turkish LLRS

– İstanbul Medical Faculty

– Memorial Hospital Sisli

– Medicana Hospital

– Ortopedia Hospital Adana

• Retrospective

• Level 4

PATIENTS & METHODS

• Combined techniques and spatial type external fixators are not included

SEGMENT TRANSPORT

ACUTE COMPRESSION &DISTRACTION

Patient

10 38

Male / female

6/4 36/2

Age 42 35

SEGMENT TRANSPORT

ACUTE COMPRESSION &DISTRACTION

Circular EX FIX 4 13

Monolateral (LRS) EX FIX

6 25

PATIENTS & METHODS

H.S 32 Y. M. Segment transport

H.S.

H.S.

H.S.

SEGMENT TRANSPORT

ACUTE COMPRESSION &

DISTRACTION

Resection 8,2 7,5

Preop defect + shortening

4 2,5

Mean ESR 50 60

Mean CRP 22 50

No statistical difference in ESR and resection amount

CRP value was significantly higher in acut COMPRESSION AND DISTRACTION group P<0,05 Preoperative shortening + defect was higher in segment transport group but not statistically significant (p>0,05)

M.C.48.Y..M. ACUTE COMPRESSıON AND DıSTRACTıON

M.C

M.C

SEGMENT

TRANSPORT

ACUTE COMPRESSION &

DISTRACTION

PROBLEM 10 24

OBSTACLE 6 15

SEQUELA 5 12

COMPLICATION

/PERSON 2,1 1,3

Complications

there is a strong trend to words increased complication rate in the segment transport group (p=0,025 Mann-Whitney U test)

SEGMENT TRANSPORT: 2 NON UNİON 4 DELAYED UNİON 3 SHORTENİNG MORE THAN 2 CM 5 DECREASE KNEE ROM 1 REFRACTURE 1 DEFORMITY

ACUT COMPRESSİON DİSTRACTİON: 13 DECREASE KNEE ROM 9 DELAYED UNİON 2 SHANZ CUT OFF 1 COLLUM FEMORIS FRACTURE 2 SHORTENING MORE THAN 3 CM

Complications

Most of the difference in complication for the segmental transport cases Docking side problems Two stage surgery increase the period of the treatment.

Results

• The patient numbers in the two study groups do not allow a sound comparison. Anyway the performed analysis display quite significant conclusion point

• The treatment period and consolidation time was longer in segment transport group. (p>0,05)

PALEY FUNCTIONAL SCORE

SEGMENT TRANSPORT

ACUTE COMPRESSION, DISTRACTION

EXCELLENT/ GOOD

4 40% 17 44%

FAİR 4 40% 17 44%

POOR 2 20% 4 11%

There is no significant differance (p>0,05)

PALEY BONE SCORE

SEGMENT TRANSPORT

ACUTE COMPRESSION DISTRACTION

Excellent / good

3 30% 22 57%

Fair 5 50% 11 28%

poor 2 20% 5 15%

Percent of excellent and good Bone score in ACD patients is higher than ST patients but not statistically significant (P>0,05)

S.K. 41 Y.F.

Take Home Message

• External fixation techniques provide excellent solutions to these problems

– ST and ACD are two techniques

– Althougth there is no significant differences between two groups, the trend displays a lower EFI and concludingly lower complication rate in the ACD group

Necrotic and infected tissues debridment is the main stay of the chronic osteomyelitis treatment

The infection its self and the debridment of the surgeon cause big amount of bone loss

In Memoriam...