title: Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases.
abstract: 42 patients with diaphyseal bone defects (25 tibial and 17 femoral) who were treated by radical debridement and bone transport are reviewed. Their mean age was 35 (10-64) years and there were 29 men. 19 patients had active infections with drainage and 9 were previously infected. After resection of the infected and necrotic bone, the intercalate defect averaged 6 (3-12) cm. The mean duration of treatment was 10 (20-52) months. Regeneration of the distraction gap was achieved in all 42 patients. Union at the target zone was achieved in 38, and in the remaining 4 cases consolidation was achieved by application of autogenous bone grafts. The infection was eradicated in all 28 patients treated for bone defects associated with infection, without the need for a second operation. Complications were not severe and did not affect the final results. Residual malalignment remained in 2 patients, 1 femur and 1 tibia, with 10 degrees and 8 degrees of varus deformity, respectively. The final leg-length discrepancy never exceeded 1.5 cm. Residual fixed flexion of the knee was left in 5 cases, but never exceeded 10 degrees. Loss of 5 degrees to 10 degrees of dorsiflexion of the ankle joint remained in 7 patients. There were no intraoperative or postoperative neurovascular damage or compartment syndrome. Psychological intolerance was seen in 1 young patient. All patients, but 3 returned to their previous occupation. Bone transport is a simple and safe method for successful treatment of diaphyseal bone defects.
authors.affiliation: 4th Orthopaedic Department, KAT Accident Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Polyzois
authors.forename: G
authors.initials: G
authors.lastname: Papachristou
authors.forename: K
authors.initials: K
authors.lastname: Kotsiopoulos
authors.forename: S
authors.initials: S
authors.lastname: Plessas
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery; D005269:Femur / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications* / Q000601:surgery