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Bifocal Techniques for Non-Union and Deformity

  • M. Saleh
  • A. Rees

Abstract

Patients with limb shortening and diaphyseal bone loss or deformity (angulation and/or non-union) secondary to trauma have caused a considerable challenge to orthopaedic surgeons. Deformity correction alone using modern techniques such as nailing and external fixation may leave residual shortening, resulting in concomitant disability. Segmental skeletal defects due to trauma or resection of bone for infection have conventionally been treated with massive autogenous cancellous bone grafts (Christian et al 1989), or vascularized bone grafts (Weiland et al 1983a, 1983b). In the case of infection, sequestration of the graft is a problem. In such situations resection of the bone, granulation of the bed and Papineau type open grafting (Papineau et al 1979) have been used. These methods may not be capable of allowing realignment or restoration of limb length and may be associated with significant donor site morbidity.

Keywords

External Fixation Docking Site Limb Length Discrepancy Bone Transport Circular Frame 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Cattaneo A., Catagni M., Johnson E.E. ‘The treatment of infected non-unions and segmental defects of the tibia by the methods of Ilizarov’. Clin Orthop1992; 280: 143–52.PubMedGoogle Scholar
  2. Catagni M. Personal communication 1992.Google Scholar
  3. Christian E.P., Bosse M.J., Robb G. ‘Reconstruction of large diaphyseal defects, without free fibular transfer, in grade HIB tibial fractures’. J Bone Joint Surg[Am] 1989; 71A: 994–1004. Google Scholar
  4. Dagher F., Roukoz S. ‘Compound tibial fractures with bone loss treated by the Ilizarov technique’. J Bone Joint Surg[Br] 1991; 73B: 316–21. Google Scholar
  5. Giebel G. ‘Resektionsdebridement mit kompensatorischer Kallusdistraktion’.Unfallchirurg 1991; 94: 401–8.PubMedGoogle Scholar
  6. Green S.A., Jackson J.M., Wall D.M., Marinow H., Ishkanian J. ‘Management of segmental defects by the Ilizarov intercalary bone transport method’. Clin Orthop 1992; 280:136–42.PubMedGoogle Scholar
  7. Ilizarov G.A., Ledyaev V.I. ‘The replacement of long tubular bone defects by lengthening by distraction osteotomy of one of the fragments’, in Clin Orthop 1992; 280: 7–10. (Original in Russian Vestn Khir 1969; 102: 77).PubMedGoogle Scholar
  8. Kreibich N., Scott L, Wells J., Saleh M. ‘Donor site morbidity after conventional and percutaneous bone graft harvesting’. Accepted J Bone Joint Surg [Br] 1994; 76B: 847–8. Google Scholar
  9. Marsh J.L., Prokuski L.J., Biermann J.S. Comparison of conventional treatment vs bone transport for the treatment of chronic infected non-union of the tibia.Clin Orthop 1994; 301:139–49.PubMedGoogle Scholar
  10. Morandi M., Zembo M.M., Ciotti M. ‘Infected tibial pseudarthosis -a 2-year follow-up on patients treated by the Ilizarov Technique’.Orthopaedics 1989; 12: 497–508.Google Scholar
  11. Paley D., Catagni M.A., Argnani F., Villa A., Benedetti G.B., Cattaneo R. ‘Ilizarov treatment of tibial non-unions with bone loss’.Clin Orthop 1989; 241: 146–65.PubMedGoogle Scholar
  12. Papineau L.J., Alfageme A., Dalcourt J.P., Pilon L. ‘Chronic osteomyelitis; excision and open cancellous bone grafting after extensive saucerisation’.Int Orthop 1979; 3:165–76.PubMedCrossRefGoogle Scholar
  13. Raschke M.J., Mann J.W., Oedekoven G., Claudi B.F. ‘Segmental transport after unreamed intramedullary nailing’.Clin Orthop .1992; 282: 233–40.PubMedGoogle Scholar
  14. Ribbans W.J., Stubbs D.A., Saleh M. ‘Non-union Surgery Part II.The Sheffield Experience - 100 consecutive cases, results and lessons’. Int J Orthop Trauma 1992; 2: 19–24.Google Scholar
  15. Saleh M., Harriman P., Edwards D.J. ‘A radiological method for producing precise limb alignment’. J Bone Joint Surg [Br] 1991;73B: 515–6.Google Scholar
  16. Saleh M. ‘Non-union Surgery Part I. Basic Principles of Management’ Int J Orthop Trauma 1992a; 2: 4–18.Google Scholar
  17. Saleh M. ‘Technique selection in limb lengthening: The Sheffield Practice’. Seminars in Orthop 1992b; 7: 137–51.Google Scholar
  18. Saleh M., Scott B.W. ‘Pitfalls and Complications of Leg Lengthening: The Sheffield Experience’. Seminars in Orthop 1992; 7:207–222.Google Scholar
  19. Saleh M. ‘Bone Grafting Harvesting: a percutaneous technique’. J Bone Joint Surg [Br] 1991; 73B: 867–8.Google Scholar
  20. Saleh M., Stubbs D.A., Street RJ., Lang DM., Harris S.C. Histologic Analysis of human lengthened bone. J Paed Orthop 1993; 2[B]: 16–21.CrossRefGoogle Scholar
  21. Saleh M., Hamer A. ‘Bifocal lengthening - preliminary results’J Paed Orthop 1993; 2[B]: 42–8.CrossRefGoogle Scholar
  22. Sveshnikov A.A., Barabash A.P., Chepelenko T.A., Smotrova L.A., Larionov A.A. ‘Radionuclide studies of osteogenisis and circulation in substitution of large defects of the leg bones’ in Experiment Ortop Travmatol Protex 1984; 11: 33–7.Google Scholar
  23. Weiland A.J., Moore J.R., Daniel R.K. ‘Vascularised bone grafts. Experience with 41 cases’. Clin Orthop 1983a;174: 87–95.PubMedGoogle Scholar
  24. Weiland A.J., Moore J.R., Hotchkiss R.N. ‘Soft tissue procedures for reconstruction of tibial shaft fractures’. Clin Orthop 1983b; 178: 42–53.PubMedGoogle Scholar

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© Springer-Verlag London Limited 2000

Authors and Affiliations

  • M. Saleh
  • A. Rees

There are no affiliations available

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