title: Management of combined bone defect and limb-length discrepancy after tibial chronic osteomyelitis.
abstract: Bone defects and leg shortening due to chronic osteomyelitis are rare yet challenging problems to treat. The aim of this study was to summarize our experience with a distraction osteogenesis technique performed with an external fixator for these conditions. Twenty-three consecutive patients with tibial bone defects and limb-length discrepancy caused by osteomyelitis were treated from January 1994 to January 2009. Thirteen boys and 10 girls had a mean age of 12.2 years (range, 8-16 years). Twenty of the 23 patients (87.0%) had undergone an unsuccessful bone grafting procedure. Mean amount of bone defect was 3.6 cm (range, 1.5-6.2 cm) as measured on plain radiographs. Mean leg-length discrepancy was 4.0 cm (range, 0-8.0 cm). All patients were followed for a mean of 116 months (range, 31-182 months). Mean external fixation index was 48.0 days/cm (range, 40.7-66.5 days/cm). Mean lengthening was 9.3 cm (range, 5.8-12.1 cm). Based on the criteria recommended by Paley et al, 16 bone results were excellent, 6 good, and 1 fair. Fifteen functional results were excellent, 7 good, 1 fair, and 0 poor. This study shows that distraction osteogenesis with an external fixator is an effective treatment for massive postosteomyelitis bone defects and leg shortening.
authors.affiliation: Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
authors.forename: Tang
authors.initials: T
authors.lastname: Liu
authors.forename: Xiangsheng
authors.initials: X
authors.lastname: Zhang
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Li
authors.forename: Dan
authors.initials: D
authors.lastname: Peng
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D016267:External Fixators; D005260:Female; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D016348:Osseointegration; D019857:Osteogenesis, Distraction; D010019:Osteomyelitis / Q000150:complications / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome