Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss.
BACKGROUND
Nonunions of a juxta-articular lesion with bone loss, which represent a challenging therapeutic problem, were treated using external fixation and distraction osteogenesis.


METHODS
Seven juxta-articular nonunions (five septic and two aseptic) were treated. The location of the nonunion was the distal femur in four patients, the proximal tibia in one patient, and the distal tibia in two patients. All of them were located within 5 cm from the affected joints. Preoperative limb shortening was present in six cases, averaging 2.9 cm (range, 1-7 cm). The reconstructive procedure consisted of refreshment of the nonunion site, deformity correction, stabilization by external fixation, and lengthening to eliminate leg length discrepancy or to fill the defect. Shortening-distraction was applied to six patients and bone transport to one patient for reconstruction. Intramedullary nailing to reduce the duration of external fixation was simultaneously performed in two cases. All the patients had at least 1 year of follow-up evaluation.


RESULTS
Osseous union without angular deformity or leg length discrepancy greater than 1 cm was achieved in all patients. The mean amount of lengthening was 5.8 cm (range, 2.2-10.0 cm). The mean external fixation period was 219 days (range, 98-317 days), and the mean external fixation index was 34.4 days/cm (range, 24.5-47.6 days/cm). All patients reported excellent pain reduction. There were no recurrences of infection in five patients with prior history of osteomyelitis. The functional results were categorized as excellent in two, good in three, and fair in two.


CONCLUSIONS
Despite the length of postoperative external fixation, distraction osteogenesis can be a valuable alternative for the treatment of juxta-articular nonunions.
Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Ishikawa 920-8641, Japan.
Tamon
T
Kabata
Hiroyuki
H
Tsuchiya
Keisuke
K
Sakurakichi
Teruhisa
T
Yamashiro
Koji
K
Watanabe
Kasuro
K
Tomita
D000293:Adolescent; D000328:Adult; D000368:Aged; D003646:Debridement; D020878:Device Removal; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000009:adverse effects; D010027:Osteotomy; D011859:Radiography; D019651:Plastic Surgery Procedures; D013530:Surgical Wound Infection; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*