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International Orthopaedics

, Volume 43, Issue 5, pp 1051–1059 | Cite as

Mechanical solutions to salvage failed distraction osteogenesis in large bone defect management

  • Dmitry Y. BorzunovEmail author
  • Alexander L. Shastov
Original Paper

Abstract

Introduction

Ilizarov bone transport for large bone defect is challenging and may end in distraction osteogenesis failure.

Material and methods

Ten forearm and seven tibial defect cases with failed regeneration due to ischaemia during bone transport were studied retrospectively. Mean forearm and tibial defects were 5.5 ± 0.8 and 7.6 ± 1 cm respectively, or 22.3 ± 3.6 and 20 ± 2.3% as compared with healthy segments. Most patients had numerous previous operations (2.6 ± 0.5 and 3.4 ± 0.8 per patient, respectively), extensive scars locally and post-traumatic neuropathy. There were seven infected defects. Mechanical solutions used were (1) additional osteotomy and transport of the fragment to compact the ischaemic regenerate (10 forearms, 4 tibias) and (2) compaction of the connective tissue layer in the tibial regenerate with either two 5-mm steps (two cases) or gradually (one case).

Results

Bone integrity was restored in all the cases. Complete compensation of the defects was achieved in 12 patients with the first technique. Two patients with 8-cm ulna defects remained with residual discrepancy. In the forearm, mean compaction was 1.7 ± 0.4 cm. It took 25.7 ± 5.4 days followed by an average fixation period of 107.1 ± 11.8 days. In the tibia, mean longitudinal compaction by distraction measured 1.7 ± 0.8 cm. The second technique ended up with an acceptable shortening of 1 cm in two cases. Four centimeters were compressed in the third case gradually.

Conclusion

The technical solutions used for mechanical effects on the ischaemic distraction regenerate resulted in its rescue and bone union in all the cases.

Keywords

Bone defect Bone fragment Ilizarov transport Distraction osteogenesis Bone callus Failed regeneration Compression 

Notes

Acknowledgements

The authors would like to thank Tatiana Malkova from the medical information service of our institute for her contribution to the literature review and English language interpretation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Russian Ilizarov Scientific Center for Restorative Traumatology and OrthopaedicsKurganRussian Federation

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