Vázquez TM, Penagos PA, Casiano GG

Language: Spanish
References: 12
Page: 172-177
PDF size: 171.45 Kb.

ABSTRACT

Introduction. The performing of osteogenesis by distraction in patients elder than their sixth decade of life is controversial and, up to the moment, the results have been scarcely satisfactory. Objective. To present our experience in femur bony transportation in a patient being in her sixth decade of life and suffering from a bony loss secondary to an atrophic septic pseudoarthritis. The Case Report. This study reports the case of a female patient of 52 years old having been diagnosed atrophic septic pseudoarthritis in the left femur, as well as a 12-centimeter bony loss. The treatment consisted of two surgical times, the first one of debridement and the second time of setting an Orthofix long elongator, besides the performing of a femoral osteotomy. The patient was subjected to a femoral transportation at a speed of 0.5 millimeters per day. When getting to the fragment transported to the distal femur, it was practiced the application of an autologous bony grafting. The time of the bony transportation was of 200 days. The corticalization and consolidation of the newly-shaped bone was obtained in a period of 600 days. During the treatment period, there were some complications, as follows: soft-part superficial infection and knee articular stiffness. These problems were solved through antibiotic therapy and knee physiotherapy. The total bony distraction that was obtained was of 12 centimeters. Conclusions. The obtained bony transportation allowed to achieve a proper functionality of the lower left member, and a length as long as the bony loss was obtained. The complications being present were solved during the treatment period.

REFERENCES

1. Wu CC, Shih CH, Chen WJ: Nonunion and shortening after femoral fracture treated with on-stage lengthening using locked nailing technique. Acta Orthop Scand 1999; 70(1): 33-6.

2. Gualdrini G, Stagini C, Fravisini M, Giunti A: Infected nonunion of the femur. Chir Organi Mov 2002; 87(4): 225-33.

3. Jain AK, Sinha S: Infected nonunion of the long bones. Clin Orthop Relat Res 2005; (431): 57-65.

4. Barker KL, Lamb SE, Simpson AH: Functional recovery in patients with nonunion treated with the Ilizarov technique. J Bone Joint Surg Br 2004; 86(1): 81- 5.

5. Yasui N, Nakase T, Kawabata H, Shibata T, Helland P, Ochi T: A technique of percutaneous multidrilling osteotomy for limb lengthening and deformity correction. J Orthop Sci 2000; 5(2): 104-7.

6. Giannikas KA, Maganaris CN, Karski MT, Twigg P, Wilkes RA, Buckle JG: Functional outcome following bone transport reconstruction of distal tibial defects. J Bone Joint Surg Am 2005; 87(1): 145-52.

7. Atesalp AS, Komurcu M, Basbozkurt M, Kurklu M: The treatment of infected tibial nonunion with aggressive debridement and internal bone transport. Mil Med 2002; 167(12): 978-81.

8. Sangkaew C: Distraction osteogenesis for the treatment of post traumatic complications using a conventional external fixator. A novel technique. Injury 2005; 36(1): 185-93.

9. Raschke MJ, Stosch-Wechert K, Weiler A, Khodadadyan C, Haas N: Distraction of hypertrophic callus in the treatment of segmental bone loss in the femur: A case report. J Bone Joint Surg Am 2000; 82(1): 101-4.

10. Noonan K, Leyes M, Forriol F, Canadell J: Distraction osteogenesis of the lower extremity with use of monolateral external fixation: A study of two hundred and sixty-one femora and Tibiae. J Bone Joint Surg Am 1998; 80(6): 793-806.

11. Marsh DR, Shah S, Elliott J, Kurdy N: The Ilizarov Method in nonunion, malunion and infection of fractures. J Bone Joint Surg Br 1997; 79(2): 273-279.

12. Orona JJ, Vázquez M. Recuperación de pérdidas óseas de tibia mediante transporte óseo con fijadores externos. Acta Ortop Mex 2005; 19(2): 42-8.