Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 3, May-June, p. 403–409

Publication type: original article

Language: English

Treatment of Infected Nonunion of Long Bones

Leczenie zakażonych stawów rzekomych kości długich

Paweł Reichert1,, Roman Rutowski1,2,, Jerzy Gosk1,, Krzysztof Zimmer1,, Roman Wiącek1,

1 Department and Clinic of Traumatology and Hand Surgery, Silesian Piasts University of Medicine in Wrocław, Poland

2 Department of Medicine of Sport, Wrocław University of Physical Education, Poland

Abstract

Background. Despite advances in contemporary orthopedics, nonunion of long bones is still a major problem. In an infected nonunion we must treat osteomyelitis and nonunion together.
Objectives. The purpose of the study was to evaluate the results of treating infected nonunion of long bones by local antibiotic bead chains (Septopal−gentamicin) with autogenous bone graft.
Material and Methods. Fourteen patients were treated between 2001–2005 at the Clinic of Traumatology and Hand Surgery, Silesian Piasts University of Medicine in Wrocław, because of infected nonunion of a long bone. The time from fracture to operation was from 6 to 18 months. According to the Cierny−Mader classification of osteomyelitis, 6 patients were in stage IVA, 4 in stage IVB, and 4 in stage IIIA. The size of the defect before bone grafting ranged from 2 to 5 cm. The duration from debridement to bone graft ranged from 4 to 10 weeks.
Results. Bone union was achieved in 10 of the 14 patients. The mean time of bone union achievement was 9 months. Union in cases of IVB of the Cierny−Mader classification were usually not obtained.
Conclusion. Use of antibiotic bead chains with cancellous bone graft produced satisfactory results in the treatment of infected nonunion. The treatment results of infected nonunion depended on the kind of osteomyelitis in the Cierny−Mader classification.

Streszczenie

Wprowadzenie. Leczenie stawów rzekomych pomimo znacznego postępu technik operacyjnych nadal jest bardzo trudnym problemem ortopedycznym. W przypadkach zakażonych stawów rzekomych postępowanie terapeutyczne obejmuje zarówno leczenie zapalenia kości, jak i zaburzeń zrostu kości.
Cel pracy. Ocena wyników leczenia zakażonych stawów rzekomych kości długich za pomocą koralików gentamycynowych (Septopal) i autogennego wszczepu kości.
Materiał i metody. Wlatach 2001–2005 w Klinice Chirurgii Urazowej i Chirurgii Ręki AM we Wrocławiu leczono 14 chorych z powodu zakażonych stawów rzekomych kości długich. Czas od złamania do operacji wynosił 6–18 miesięcy. Zapalenie kości według klasyfikacji Cierny−Madera u 6 chorych określono typem IVA, u 4 chorych IIIA, u 4 chorych IVB. Długość stosowanego wszczepu wynosiła 2–5 cm. Czas od oczyszczenia ogniska zapalnego do zastosowania przeszczepu wynosił 4–10 tygodni.
Wyniki. Zrost kostny uzyskano u 10 chorych na 14 leczonych. Średni czas uzyskania zrostu kostnego wynosił 9 iesięcy. Niepowodzenia dotyczyły głównie chorych z typem IVB zapalenia kości.
Wnioski. Leczenie za pomocą Septopalu i autogennego wszczepu kości daje dobre wyniki w przypadkach zakażonych stawów rzekomych. Wyniki leczenia stawów rzekomych zależą od stopnia zapalenia w klasyfikacji Cierny−Madera.

Key words

infected nonunion, osteomyelitis, bone graft

Słowa kluczowe

zakażony staw rzekomy, zapalenie kości, wszczep kostny

References (24)

  1. Kanellopoulos A, Soucacos P: Management of nonunion with distraction osteogenesis. Injury, Int J Care Injured 2006, 37S, S51–55.
  2. Wiss D, Stetson W: Tibial nonunion: treatment alternatives. J Am Acad Ortop Surg 1996, 4, 249–257.
  3. Cattaneo R, Catagni M, Johnson E. The treatment of infected non−unions and segmental defects of the tibia by the methods of Ilizarow. Clin Orthop 1992, 280, 143–152.
  4. Hirschberg J, Rees R, Marchant B, Dean S: Osteomyelitis related to pressure ulcers: the cost of neglect. Adv Skin Wound Care 2000, 13, 25–29.
  5. Tylman D, Dziak A: Traumatologia narządu ruchu. PZWL Warszawa 1996.
  6. Panda M, Ntungila N, Kalunda M, Hinsenkamp M: Treatment of chronic osteomyelitis using the Papineau technique. Int Orthop 1998, 22, 37–44.
  7. Lei H, Yi L: One stage open cancellous bone grafting of infected fracture and nonunion. J Orthop Sci 1998, 3, 318–323.
  8. Cierny G, Mader J, Pennick: A clinical staging for adult osteomyelitis. Contemp Orthop 1985, 105, 17–37.
  9. Lindsey R, Probe R, Miclau T, Alexander J, Perren S. The effects of antibiotic−impregnated autogenic cancellous bone graft on bone healing. Clin Orthop 1993, 291, 302–312.
  10. Klemm K: The use of antibiotic−containing bead chains in the treatment of chronic bone infections. Clin Microbiol Infect 2001, 7, 28–31.
  11. Green S, Jackson J, Wall D, Marinow H, Ishkanian J: Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop 1992, 28, 136–142.
  12. Plakseychuk A, Plakseychuk Y, Gruen G, Ziran B: Treatment of ostoemyelitis with Ilizarow frame. Oper Tech Orthop 2002, 12, 4, 273–281.
  13. Minami A, Kaneda K, Itoga H: Treatment of infected segmental defect of long bone with vascularized bone transfer. J Reconstr Microsurg 1992, 8, 75–82.
  14. Hou S, Liu T: Reconstruction of skeletal defects in the femur with two−strut free vascularized fibular grafts. J Trauma 1992, 33, 840–845.
  15. Esterhai J et al.: Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posteolateral bone graft, and soft tissue transfer. J Trauma 1990, 30, 49–54.
  16. Gordon L, Chiu E: Treatment of infected non−unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone grafting. J Bone Joint Surg 1988, 70, 377–386.
  17. Karamitros A, Kalentzos V, Soucacos P: Electric stimulation and hyperbaric oxygen therapy in the treatment of nonunions. Injury, Int J Care Injured 2006, 37S, S63–S73.
  18. Mast N, Horwitz D: Osteomyelitis: A review of current literature and concepts. Oper Tech Orthop 2002, 12, 4, 232–241.
  19. Lavelle D: Delayed union and nonunion of fractures. In: Campbell’s Operative Orthopaedics, Ed.: Canale ST 10th ed. Vol. 3. Mosby, St. Louis, 3125–3127.
  20. Stein H, Lerner A: Advanced in the treatment of chronic osteomyelitis. Curr Orthop 2001, 15, 451–456.
  21. Chin−En C, Jih−Yang K, Cheng−Chung P: Results of vancomycin−impregnated cancellous bone grafting for infected tibial nonunion. Arch Orthop Trauma Surg 2005, 125, 369–375.
  22. Patzakis M, Mazur K, Wilkins J, Sherman R, Holtom P: Septopal beads and sutogenes bone grafting for bone defects in patients with chronic osteomyelitis. Clin Orthop 1993, 295, 112–118.
  23. Klemm K: Antibiotic bead chains. Clin Orthop 1993, 295, 63–76.
  24. Stewart MJ, Hundley JM: Fractures of the humerus: a comparative study in methods treatment. J. Bone Joint Surg. 1995, 37, 681–692.
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