Segmental Resection and Bone Transport Distraction Osteogenesis in the Management of Chronic Osteomyelitis

Purpose: A clinical retrospective study of surgical treatment of chronic posttraumatic osteomyelitis by the Ilizarov method was conducted by analyzing the end results.The aim was to evaluate the efficacy of distraction osteogenesis in covering large bone defects and eradicate infection. Materials and method: Between 1990–2000, twenty-one patients with chronic osteomyelitis were surgically treated. Inclusion criteria were: 1) active infection of more than six months and 2) bone defect (after the surgical debridement was completed) > 4cm.The average length of bone defect was 9,5 cm. (4–28cm.). In all cases corticotomy and application of the Ilizarov device was necessary to initiate bone transport.The protocol of the Association for the Study and Application of the Method of Ilizarov (A.S.A.M.I), was used to evaluate the results. All patients were examined clinically and radiographically in order to assess the proper alignment, the progress of bone healing and possible signs of infection. Result: Thirteen patients (62%) presented delayed union at the docking site. In 4 patients compression –distraction was necessary to promote union. In 9 patients (43%) the Ilizarov device was removed and interlocked intramedullary nailing was performed after eradication of the infection was confirmed by clinical and laboratory data. Recurrence of infection occurred in one patient. Elimination of infection and solid bone formation was the end result for all patients. Two refractures at the docking site needed reapplication of an Ilizarov device. In one case angular deformity of more than 10 degrees needed correctional osteotomy. Conclusions: The Ilizarov method addresses successfully infection, bone defect, deformity, and leg length discrepancy simultaneously. All these may coexist in difficult cases of chronic osteomyelitis. Complications associated specifically with bone transport in exceeded bone defects ,after radical resection of infected bone, include certainly delayed union or non-union at the docking site and prolonged treatment time.