Date: Thu, 08 Feb 2001 18:40:27 -0500
From: Michael Sirkin
Subject: Infected tibia nonunion
This is a 45 year old gentleman who 8 years ago sustained a midshaft tibia fracture originally treated with plate and screws which became infected. The plate and screws were removed, dead bone was resected and Ilizarov was placed with proximal corticotomy and transport into distal defect. Multiple complications during this including refracture and infection.
He now shows up in my clinic with pain and deformity as seen in the images. He has a draining sinus which drains on and off intermittently. He really wants to save his leg but i think an amputation will serve him best. He has a rigid ankle and midfoot. Currently his ankle is fixed in about 10 degrees of dorsiflexion. He ambulates with crutches because of his pain. He has sensation distally with good capillary refill, no palpable pulse. Angiogram shows all 3 vessels present in leg.
How many think he should have an amputation and how many would try reresection, flap and transport.
Date: Fri, 9 Feb 2001 05:12:12 -0800
From: bruce meinhard
I would give it one more shot to gain a well aligned leg. This might require a soft tissue release at the ankle or an arthrodesis as a secondary procedure. First a soft tisue procedure like a flap to bring in quality tissue and at 4-6 weeks after that another ilizarov and corticotomy to correct the deformity more gradually. The foot could also be included to correct its deformity at the same time, or the ankle and foot could be taken care of at a later date. This would only mildly prolong his treatment phase.I would like to hear from our Russian Friend and correspondent Alex as well on this. Looking forward to seeing you again at your lecture this month at Stony Brook
Date: Fri, 9 Feb 2001 11:11:07 -0000
From: Nuno Craveiro Lopes
In spite of infection this is a hypertrophic pseudarthrosis so it will consolidate and the infection "will burn out on the fire of the regenerate" as Ilizarov used to say. So I advise you to use a Ilizarov frame again to do simultaneous axial correction and if necessary, lengthening without any surgical approach to the lesion. I attach a sketch of the proposed frame and a clinical case.
|A,B) Finding the hinge point. C) Frame assembly. D) Correction.|
|A) Pre-op: Infected hypertrophic pseudarthrosis.
B) Frame assembly at the beginning of correction.
C) Frame assembly at the end of correction. 5 months in frame.
D) Final result.