[The value of intramedullary boring and intramedullary splinting in revision of infected pseudarthroses].
In the treatment of pseudarthrosis with only a segmental loss of bone elements a reconstruction by the Ilizarov method is too complicated, and simple decortication and plastic surgery with cancellous bone grafting is usually too slow. With reference to three cases, it is shown that simultaneous debridement and bone reaming can improve clearance of the infection. Using decortication and autologous cancellous bone grafting, it is possible to leave the center of the bone free by temporarily inserting a silicon tube. As a result cancellous bone can be saved and the danger of a relapse will be minor. In two cases this technique with the central silicon tube was applied for the first time within the scope of plastic surgery with cancellous bone. If, as in the third case, there is enough bone substance in the region of the pseudarthrosis with swelling of the soft tissue or fistulation, in selected cases reaming of the bone cavity and decortication are all that is necessary. The average length of follow up was 19 months. Only in one of our cases did local inflammation recur 9 months after clearance, which healed rapidly with conservative procedures. The other patients had no episodes of this nature. In our group, the patients achieved full weight-bearing on their leg without external support in an average of 5 months. Compared with another study conducted in Liestal, in which a similar group (infected pseudarthrosis with bone defects of 4-11 cm) was treated by the Ilizarov technique, shortening of the treatment by an average of 4 months was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Ochsner
P E
PE
Orthopädische Klinik, Kantonsspital Liestal.
Hügli
R W
RW
D000328:Adult; D001853:Bone Marrow / Q000601:surgery*; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008768:Methylmethacrylates / Q000008:administration & dosage; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011542:Pseudarthrosis / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D013978:Tibial Fractures / Q000601:surgery*
D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead
Der Wert der Markhöhlenaufbohrung und Markraumschienung bei der Sanierung von Infektpseudarthrosen.