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ISSN 1684-1824 (Electronic)

2021, Number 5

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Rev Méd Electrón 2021; 43 (5)

Treatment of tibia septic pseudo arthritis secondary to exposed fracture. Apropos of a case

Hernández-Valera D, Pancorbo-Sandoval E, Delgado-Quiñones A, Echevarría-Borges Y, Quesada-Pérez JA, Díaz-Prieto G

Language: Spanish
References: 17
Page: 1436-1444
PDF size: 1060.73 Kb.


ABSTRACT

Exposed tibia fractures have been one of the most important problems for public health care systems. They are characterized by three main risk factors: bone and soft tissue damage, high possibilities of contamination and difficulties for the surgical and conservative treatment, due to the associated bone and soft tissues damage implying a high rate of complications. The treatment of these fractures is a widely discussed topic regarding the surgical technique to be used. Due to poor vascularization and little quantity of soft tissue covering tibia, this bone is highly vulnerable to pseudoarthritis and infection. The aim of this work was to describe the surgical technique of bone transport with Ilizarov external fixator and to evaluate the result in tibial bone defects of more than 6 cm, secondary to infected pseudoarthritis. As a result, the patient evolved with septic pseudoarthritis of right tibia secondary to exposed fracture. The follow up lasted 18 months; the bone loss was 6 cm; the distraction speed was 1 mm/day; the transportation period was 95 days and the time with fixator was 198 days. It was necessary to perform a new surgical procedure at the contact site to recuperate the bone ends. Bone transport with Ilizarov fixator is valid for the bone loss treatment in tibia exposed fractures or septic pseudo arthritis.


REFERENCES

  1. KeatingJF, SimpsonAH, RobinsonCM. The management of fractures with bone loss. J Bone Joint Surg Br[Internet]. 2005[citado 20/11/2020];87(2):142-50.Disponible en:Disponible en:https://doi.org/10.1302/0301-620X.87B2.15874

  2. BegueT, AureganJC. Acute Management of Traumatic Bone Defects in the Lower Limb[Internet]. En: BentleyG,ed.European Instructional Lectures,15th EFFORT Congress, London, United Kingdom. V. 14.Heidelberg: Springer;2014. p. 71-83[citado 20/11/2020].Disponible en: Disponible en: https://doi.org/10.1007/978-3-642-54030-1_7

  3. Ganchozo PincayMM, Altamirano OlveraCD, Patiño AndradeRP,et al. Determinar las complicaciones de las fracturas expuestas de tibia en pacientes de 20-40 años en el hospital Teodoro Maldonado Carbo periodo 2014. Recimundo [Internet]. 2019 Oct[citado 20/11/2020];3(3):807-23.Disponible en: Disponible en: http://recimundo.com/index.php/es/article/view/550

  4. IlizarovGA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989 Jan;(238):249-81. Citado en PubMed; PMID: 2910611.

  5. IlizarovGA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res. 1989 Feb;(239):263-85.Citado en PubMed; PMID: 2912628.

  6. MolinaCS, StinnerDJ, ObremskeyWT. Treatment of Traumatic Segmental Long-Bone Defects: A Critical Analysis Review. JBJS Rev. 2014 Apr ;2(4):01874474-201404000-00003. Citado en PubMed; PMID: 27490871.

  7. TsuchiyaH, TomitaK. Distraction osteogenesis for treatment of bone loss in the lower extremity. J Orthop Sci. 2003;8(1):116-24. Citado en PubMed; PMID: 12560898.

  8. AronsonJ. Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg Am. 1997 Aug;79(8):1243-58.Citado en PubMed; PMID: 9278087.

  9. PaleyD, MaarDC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma. 2000 Feb;14(2):76-85. Citado en PubMed; PMID: 10716377.

  10. DeCosterTA, GehlertRJ, MikolaEA,et al. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg. 2004 Jan-Feb;12(1):28-38. Citado en PubMed; PMID: 14753795.

  11. SchadeAT, HindJ, KhatriC,et al. Systematic review of patient reported outcomes from open tibia fractures in low and middle income countries. Injury. 2020 ;51(2):142-6. Epub 2019 Nov 11. Citado en PubMed; PMID: 31767370.

  12. Laborda OliveraHF,Viacava SiazaroFA,NoriaA,et al.Tratamiento de defectos masivos de tibia. Técnica de transporte óseo con fijador AO*.AnFaMed[Internet]. 2018 Dic [citado 20/11/2020];5(2):130-40. Disponible en: Disponible en: https://doi.org/10.25184/anfamed2018v5n2a12

  13. Delgado del CañoJ,García LópezR,Rodríguez de OyaC. Pseudoartrosis séptica. Actualización en manejo y tratamiento.Rev Esp Traum Lab [Internet]. 2019[citado 20/11/2020];2(1):25-31.Disponible en: Disponible en: https://www.fondoscience.com/retla/vol02-fasc1-num03/fs1901003-pseudoartrosis-septica-actualizacion-en-manejo

  14. Velázquez-MorenoJD,Casiano-GuerreroG.Algoritmo del tratamiento de la seudoartrosis diafisaria. Acta Ortop Mex [Internet].2019[citado 20/11/2020];33(1):50-7.Disponible en:Disponible en:https://www.medigraphic.com/pdfs/ortope/or-2019/or191l.pdf

  15. RoddyE, PattersonJT, KandemirU. Delay of Antibiotic Administration Greater than 2 Hours Predicts Surgical Site Infection in Open Fractures. Injury. 2020 Sep;51(9):1999-2003.Epub 2020 May 12. Citado en PubMed; PMID: 32482427.

  16. BattistonB, SantoroD, BaidoRL,et al. Treatment of acute bone defects in severe lower limb Trauma. Injury. 2019 Dec;50(Suppl 5):S40-5.Epub 2019 Oct 23. Citado en PubMed; PMID: 31708086.

  17. RohillaR, SiwachK, DevganA,et al. Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia. J Clin Orthop Trauma. 2016 Oct-Dec;7(Suppl 2):201-9. Epub 2016 Apr 20. Citado en PubMed; PMID: 28053385.




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