Reconstruction of Massive Tibial Defect Caused by Osteomyelitis Using Induced Membrane Followed by Trifocal Bone Transport Technique: a Retrospective Study and Our Experience

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2021 Dec 16

PMID 34911504

Citations 6

Authors

Yimurang Hamiti

Maimaiaili Yushan

Cheng Lu

Aihemaitijiang Yusufu

Affiliations

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Abstract

Objective: To evaluate clinical outcomes of the application of induced membrane followed by trifocal bone transport technique in the treatment of massive tibial defect caused by osteomyelitis.

Method: A total of 18 eligible patients with tibial defect > 6 cm caused by osteomyelitis who were admitted to our institution from January 2010 to January 2016 and treated by induced membrane followed by trifocal bone transport technique. There were 12 male and 6 females with an average age of 40.4 years old. A detailed demographic data (age, sex, etiology, previous operation time, defect size and location, interval from Masquelet technique to trifocal bone transport technique, external fixation index (EFI), duration of regenerate consolidation and docking union) were collected, bone and functional outcomes were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during and in the period of follow up were recorded and evaluated by Paley classification at a minimum follow-up of 2 years.

Results: The etiology include posttraumatic osteomyelitis in 13 cases and primary osteomyelitis in 5 cases. An average of previous operation time was 3.4 times. Mean tibial defect after radical debridement was 6.8 cm. An average interval duration from formation of induced membrane to trifocal bone transport was 4.8 weeks. An average of EFI was 37.1 days/cm, the duration of regenerate consolidation and docking union were 124.7 days and 186.4 days, respectively. An average time of follow-up after removal of external fixator was 28.5 month without recurrence of osteomyelitis. The bony outcome was excellent in 6 cases, good in 8 cases, fair in 3 cases and poor in 1 case, and functional outcome was excellent in 4 cases, good in 10 cases, fair in 2 cases and poor in 2 cases. The most common complication was pin tract infection which occurred in 15 cases and there were no major complications such as nerve or vascular injury.

Conclusion: Massive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes.

Citing Articles

Management strategies for Docking Site refractures: a comparative analysis of 19 patient cases.

Hamiti Y, Abudureyimu P, Lyu G, Yusufu A, Yushan M J Orthop Surg Res. 2024; 19(1):430.

PMID: 39054535 PMC: 11270954. DOI: 10.1186/s13018-024-04938-y.

Trifocal versus Pentafocal bone transport in segmental tibial defects: a matched comparative analysis for posttraumatic osteomyelitis treatment.

Hamiti Y, Abudureyimu P, Lyu G, Yusufu A, Yushan M BMC Musculoskelet Disord. 2024; 25(1):383.

PMID: 38750523 PMC: 11094878. DOI: 10.1186/s12891-024-07507-w.

Treatment of tibial bone defects caused by infection: a retrospective comparative study of bone transport using a combined technique of unilateral external fixation over an intramedullary nail versus circular external fixation over an intramedullary....

Maimaiti X, Liu K, Yusufu A, Xie Z BMC Musculoskelet Disord. 2024; 25(1):284.

PMID: 38609889 PMC: 11010327. DOI: 10.1186/s12891-024-07377-2.

Docking site interventions following bone transport using external fixation: a systematic review of the literature.

Liodakis E, Giannoudis V, Harwood P, Giannoudis P Int Orthop. 2023; 48(2):365-388.

PMID: 38148379 PMC: 10799803. DOI: 10.1007/s00264-023-06062-8.

Complications associated with single-level bone transport for the treatment of tibial bone defects caused by fracture-related infection.

Liu K, Jia Q, Wang X, Bahesutihan Y, Ma C, Ren P BMC Musculoskelet Disord. 2023; 24(1):514.

PMID: 37353801 PMC: 10288666. DOI: 10.1186/s12891-023-06527-2.

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