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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v22.i2.40
pages 137-143

Distraction over Nail Using Circular External Fixation for Septic Pseudarthrosis of the Tibia

Orestis Karargyris
Third Department of Orthopedics, Athens University Medical School, Athens, Greece
Pavlos Romoudis
Third Department of Orthopedics, Athens University Medical School, Athens, Greece
Lampros Giuseppe Morassi
Third Department of Orthopedics, Athens University Medical School, Athens, Greece
Christos Zafeiris
Third Department of Orthopedics, Athens University Medical School, Athens, Greece
Andreas F. Mavrogenis
First Department of Orthopaedics, ATTIKON University Hospital, Athens University Medical School, Athens, Greece
Vasileios Polyzois
Third Department of Orthopedics, Athens University Medical School, Athens, Greece
Spyridon G. Pneumaticos
Third Departments of Orthopaedics, Athens University Medical School, Athens, Greece

ABSTRACT

We present a report of nine patients (eight women and one man; mean age 37 years) from 2010 to 2012 with septic pseudarthrosis of the tibia treated with bone transport over an intramedullary nail using a circular external fixator. The mean follow-up was 15 months (range: 10−21 months). A twostage approach was used. At the first stage, removal of the primary osteosynthesis and extensive bone debridement to healthy, bleeding bone margins was performed. The bone defect was packed with antibiotic loaded cement beads, and stabilization of the tibia was done with a unilateral external fixator or with a long leg posterior splint. The mean size of bone defect was 4 cm (range: 3.5−5.5 cm). At the second stage, two consecutive negative wound cultures and normal values of blood cell count, C-reactive protein (CRP), and estimated sedimentation rate (ESR) were obtained. Then we reamed and locked the intramedullary nailing of the tibia, applied a circular external fixator, and performed percutaneous corticotomy of the tibia opposite the site of the bone defect. Bone distraction over the nail was initiated at the eighth postoperative day at a rate of 1 mm/day. At the last follow-up, union was achieved in all cases without recurrence of bone infection. All patients experienced excellent (n=3) or good (n=6) knee and ankle function, as well as complete return to their daily activities. Two patients experienced pin-tract infection, and one patient experienced anterior knee pain at the entry point of the nail.