Comprasion of Acute Compression and Segmental …llrs.org/PDFs/Annual Meeting Presentations/Friday...
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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 23 th Annual Scientific Meeting New York Comparison of acute compression distraction and segmental bone transport techniques in the treatment of tibia osteomyelitis Eralp Levent 1 , Sen Cengiz 1 , Dikmen Goksel 1 , Tomak Yılmaz 2 , Gulsen Mahir 3 , Balci Halil 1 , Bas Ali 1 , Kocaoglu Mehmet 4 , Çakmak Mehmet 1
Transcript of Comprasion of Acute Compression and Segmental …llrs.org/PDFs/Annual Meeting Presentations/Friday...
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
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Limb Lengthening and Reconstruction Society 23th Annual Scientific Meeting
New York
Comparison of acute compression distraction and segmental bone transport techniques in the
treatment of tibia osteomyelitis Eralp Levent1, Sen Cengiz1, Dikmen Goksel1, Tomak Yılmaz2, Gulsen Mahir3, Balci Halil1, Bas Ali1,
Kocaoglu Mehmet4, Çakmak Mehmet1
All Authors
We have no potential conflicts
with this presentation.
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LONG BONE DEFECTS
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Bone segment loss
Soft tissue loss
Leg-length discrepancy
Deformity
DEBRIDEMENT
TREATMENT TECHNIQUES
Papineau technique
Internal fixation Compression Plates
Vascularized free tissue
transfer Soft tissue Bone
Combined Technique
Biologic Adjuncts (BMP’s)
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EX FIX TECHNIQUES
Compression with circular fixator
Acute shorthening and lenghtening (bifocal)
Bone segment transport technique
Bone segment transport over an intramedullary nail with external fixator (combined technique)
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• Health of the host
• Extent of dead tissue (bone + soft tissue etc.)
CIERNY & MADER CLASSIFICATION
PATIENTS & METHODS
Multicentre
Istanbul Medical Faculty/ Memorial Hospital/ Ortopedia Hospital/Medicana Hospital
Retrospective
Level 4
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The first group; Bone Segment Transport
The second group; Acute shortening & lengthening group
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PATIENTS & METHODS
Group 1 (Bone Segment Transport)
Group 2 (Acute Shortening and
lengthening)
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The Mean Bone loss 6,9 cm 7,8 cm
Mean age 37.64 years 34.82 years
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PATIENTS & METHODS
Group 1 (Bone Segment Transport)
Group 2 (Acute Shortening+
lengthening)
Radical debridement + temporary external fixation+antibiotic-
impregnated cement
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Free Flep 5 1
Docking Site Grafting 16 8
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40y F , infected atrophic nonunion
CASE- BST
Infected segment resection+antibiotic soaked spongel (collagene) +bone segment transport
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CASE- BST
09.08.2013 14 Postop 4,5 month
CASE- BST
Postop
16,5
month
After treatment 09.08.2013 15
CASE- BST
CASE- AS&L
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33 y M First session Debridement antibiotic impregnated K wire, temporary ex fix
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Reconstruction
Acute Shortening 3 cm
CASE- AS&L
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After lengthening 7 cm
CASE- AS&L
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Postop 16,5 month
After Treatment
CASE- AS&L
Ex. Fix. Group
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• 25 Male • Motorcycle
accident • 2 prev. ops. • C-M IV B local
CASE- AS&L
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CASE- AS&L
Mann-Whitney U test was used for statistical analysis.
EFİ
EFT
BHT
Complication number per patient
Grefting
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STATISTICAL ANALYSIS
Results Group 1 (Bone Segment Transport)
Group 2 (Acute Shortening+
lengthening)
Follow up (month) 55,6 (12-66) 39,9 (13-80)
EFI (day/cm)-mean 62,60 48,39*
Paley bone score 21 excellent, 4 good, 4 poor 35 excellent, 8 good, 2 fair
Bone Healing Index(BHI) (month/cm)
1.75 1,35*
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*p<0,05
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STATISTICAL ANALYSIS
Bo
ne
He
ali
ng
Tim
e
Group Group
EF
I
COMPLICATIONS
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Group 1 (Bone Segment Transport)
Group 2 (Acute Shortening)
Problem Grade 2 pin tract infection 17 cases, Limited ROM of the ankle joint 4 case
Delayed maturation regenerate site 10 cases Grade 2 pin infection 6 case
Obstacle Bone grafting 16 cases Bone grafting 8 cases
Sequela Two nonuion Varus deformity two case
Valgus deformity two case 10⁰ procurvatum deformity one case
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COMPLICATIONS
Com
plic
ation n
um
ber
per
patients
Group
BONE SEGMENT TRANSPORT
Defects 7<cm
Vascular problems
Muscle insufficiency around foot/ankle
Patients unable to adapt postoperative rehabilitation
Healthy soft tissue envelope
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ACUTE S & L
Provide an acute (+ gradual) correction up to 7 cm with attend to foot vasculary circulation
Bone contact surface %50>
Butterfly fragment or comminuted fracture
Soft tissue defect <3 cms (Acute correction promotes primary closure of the defect)
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CONCLUSION
Bone segment transport and acute compression + lengthening technique can
be used safely for CM type 3-4 OM treatment.
Patient selection is the key point. Soft tissue envelope around the tibia!!!
There was no statistically significant differences for complications numbers
per patient between the groups.
BST has a longer EFT that’s why more complications are expected. In appropriate cases, acute compression technique may provide higher
patients satisfaction because of shorter external fixator time, EFİ,BHİ
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In Memoriam...
