Treatment of tibia septic pseudo arthritis secondary to exposed fracture. Apropos of a case
Keywords:
bone transport, exposed fractures, infected pseudo arthritisAbstract
Exposed tibia fractures have been one of the most important problems for public health care systems. They are characterized by three main risk factors: bone and soft tissue damage, high possibilities of contamination and difficulties for the surgical and conservative treatment, due to the associated bone and soft tissues damage implying a high rate of complications. The treatment of these fractures is a widely discussed topic regarding the surgical technique to be used. Due to poor vascularization and little quantity of soft tissue covering tibia, this bone is highly vulnerable to pseudoarthritis and infection. The aim of this work was to describe the surgical technique of bone transport with Ilizarov external fixator and to evaluate the result in tibial bone defects of more than 6 cm, secondary to infected pseudoarthritis. As a result, the patient evolved with septic pseudoarthritis of right tibia secondary to exposed fracture. The follow up lasted 18 months; the bone loss was 6 cm; the distraction speed was 1 mm/day; the transportation period was 95 days and the time with fixator was 198 days. It was necessary to perform a new surgical procedure at the contact site to recuperate the bone ends. Bone transport with Ilizarov fixator is valid for the bone loss treatment in tibia exposed fractures or septic pseudo arthritis.Downloads
References
2. Begue T, Auregan JC. Acute Management of Traumatic Bone Defects in the Lower Limb. En: Bentley G, ed. European Instructional Lectures, 15th EFFORT Congress, London, United Kingdom [Internet]. V. 14. Heidelberg: Springer; 2014. p. 71-83 [citado 20/11/2020]. Disponible en: https://doi.org/10.1007/978-3-642-54030-1_7
3. Ganchozo Pincay MM, Altamirano Olvera CD, Patiño Andrade RP, et al. Determinar las complicaciones de las fracturas expuestas de tibia en pacientes de 20-40 años en el hospital Teodoro Maldonado Carbo periodo 2014. Recimundo [Internet]. 2019 Oct [citado 20/11/2020]; 3(3): 807-23. Disponible en: http://recimundo.com/index.php/es/article/view/550
4. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989 Jan; (238):249-81. Citado en PubMed; PMID: 2910611.
5. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res. 1989 Feb; (239): 263-85. Citado en PubMed; PMID: 2912628.
6. Molina CS, Stinner DJ, Obremskey WT. Treatment of Traumatic Segmental Long-Bone Defects: A Critical Analysis Review. JBJS Rev. 2014 Apr 1; 2(4): 01874474-201404000-00003. Citado en PubMed; PMID: 27490871.
7. Tsuchiya H, Tomita K. Distraction osteogenesis for treatment of bone loss in the lower extremity. J Orthop Sci. 2003; 8(1): 116-24. Citado en PubMed; PMID: 12560898.
8. Aronson J. Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg Am. 1997 Aug; 79(8): 1243-58. Citado en PubMed; PMID: 9278087.
9. Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma. 2000 Feb; 14(2): 76-85. Citado en PubMed; PMID: 10716377.
10. De Coster TA, Gehlert RJ, Mikola EA, et al. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg. 2004 Jan-Feb; 12(1): 28-38. Citado en PubMed; PMID: 14753795.
11. Schade AT, Hind J, Khatri C, et al. Systematic review of patient reported outcomes from open tibia fractures in low and middle income countries. Injury. 2020 Feb; 51(2): 142-6. Epub 2019 Nov 11. Citado en PubMed; PMID: 31767370.
12. Laborda Olivera HF, Viacava Siazaro FA, Noria A, et al. Tratamiento de defectos masivos de tibia. Técnica de transporte óseo con fijador AO*. AnFaMed [Internet]. 2018 Dic [citado 20/11/2020]; 5(2): 130-40. Disponible en: https://doi.org/10.25184/anfamed2018v5n2a12
13. Delgado del Caño J, García López R, Rodríguez de Oya C. Pseudoartrosis séptica. Actualización en manejo y tratamiento. Rev Esp Traum Lab [Internet]. 2019 [citado 20/11/2020]; 2(1): 25-31. Disponible en: https://www.fondoscience.com/retla/vol02-fasc1-num03/fs1901003-pseudoartrosis-septica-actualizacion-en-manejo
14. Velázquez-Moreno JD, Casiano-Guerrero G. Algoritmo del tratamiento de la seudoartrosis diafisaria. Acta Ortop Mex [Internet]. 2019 [citado 20/11/2020]; 33(1): 50-7. Disponible en: https://www.medigraphic.com/pdfs/ortope/or-2019/or191l.pdf
15. Roddy E, Patterson JT, Kandemir U. Delay of Antibiotic Administration Greater than 2 Hours Predicts Surgical Site Infection in Open Fractures. Injury. 2020 Sep; 51(9): 1999-2003. Epub 2020 May 12. Citado en PubMed; PMID: 32482427.
16. Battiston B, Santoro D, Baido RL, et al. Treatment of acute bone defects in severe lower limb Trauma. Injury. 2019 Dec; 50(Suppl 5): S40-5. Epub 2019 Oct 23. Citado en PubMed; PMID: 31708086.
17. Rohilla R, Siwach K, Devgan A, et al. Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia. J Clin Orthop Trauma. 2016 Oct-Dec; 7(Suppl 2): 201-9. Epub 2016 Apr 20. Citado en PubMed; PMID: 28053385.
Downloads
Published
How to Cite
Issue
Section
License
All content published in this journal is Open Access, distributed under the terms of the CC BY-NC 4.0 License.
It allows:
- Copy and redistribute published material in any medium or format.
- Adapt the content.
This will be done under the following terms:
- Attribute the authors' credits and indicate whether changes were made, in which case it must be in a reasonable way.
- Non-commercial use.
- Recognize the journal where it is published.
The copyrights of each article are maintained, without restrictions.