The Outcomes of Distraction Osteogenesis over an Intramedullary Nail for the Treatment of Bone Defects in Infectious Nonunions

Objectives: The concurrent utilization of an external fixator and intramedullary nail (IMN) for segment transportation may potentially decrease the duration of external fixator implementation and reduce associated complications. This study aimed to report the outcomes of bone transport utilizing a combination of IMN and Ilizarov frame in a cohort of individuals who had tibia or femur critical -sized bone deficiency resulting from nonunion.Methods: The present research used a single-arm clinical trial design to enroll a series of patients presenting with critical-sized bone defects resulting from infectious nonunion of the tibia or femur. The study was conducted during the period of ۲۰۱۷-۲۰۲۰ in a referral Orthopedic Surgery Center located in Tehran, Iran. The management of patients with infectious nonunion was carried out through two main stages, including infection eradication and bone transportation. The process of bone healing and segment transportation was evaluated by radiographic assessment throughout the follow-up period.Results: A total of ۳۹ patients with bone defects in the tibia (۱۹ cases) or femur (۲۰ cases) with a mean age of ۳۱.۴۴ (±۱۱.۹۵, range=۱۸-۶۰) were included in this study. Twenty-nine (۷۴.۳%) patients had open fractures. The bone defect exhibited an average size of ۶.۳۱ ± ۱.۹۵ cm. The mean of the consolidation index (CI) was ۰.۹۷ (range=۰.۵۱–۱.۳۲) mo/cm, and the mean of the external fixator index was ۰.۶۷ (range=۰.۴۱-۱.۱۰). Although the CI was longer in patients with open fracture compared to those with closed fracture, the difference was not statistically significant (P=۰.۳۵۳). After the end of the two-year follow-up, complete union was observed in ۳۵ patients (۸۹.۷%).Conclusion: Intercalary segmental bone transportation using the Ilizarov technique over an IMN, as well as preserving the advantages of the conventional callotasis method, reduces the complications of long-term use of the Ilizarov frame and increases patient adherence to treatment. Level of evidence: IV

Keywords:

bone defect , Ilizarov technique , Infectious nonunion , Intramedullary nail , Segment transport