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Management of Femoral Bone Defect after Gunshot Injury using Circular External Fixator
Keywords:
Femoral bone gunshot injury, Distraction osteogenesis, Circular frame fixator, Consolidation time, Healing indexAbstract
Objectives: Retrospective evaluation of healing index (HI) and consolidation time (CT) of gunshot femoral bone loss managed using conventional Ilizarov frame (CIF) versus Talyar Spatial Frame (TSF) fixator.
Methods: This multicenter study included 15 patients had gunshot femoral bone loss of about 6 cm and average soft tissue defects of about 7 cm. External fixator was used in 9 patients, soft tissue defect was directly closed in 5 patients, using rotational flap in 5 patients, multiple Z-plasty in 2 patients and in 3 patients soft tissue defect was open managed and closed by secondary intention after application of CIF fixator. CIF fixator was used in 8 and TSF fixator in 7 patients. Mean latency period before starting distraction osteogenesis was 12.8±0.8; range: 12-14 days.
Results: Mean distraction rate was 1.2±0.3 mm/day and inter-fragmentary compression rate was 0.25 mm/day for 5-7 days. Mean consolidation time was 97.8±18.1 days, and all patients had bone lengthening for a mean of 6.4±1.2 with a mean healing index of 15.3±1.37; range: 13.2-17.3. Patients categorized according to type of fixator showed non-significant (p>0.05) difference as regards clinical data.
Conclusion: Distraction osteogenesis for gunshot femoral bone injuries could be achieved successfully using either Ilizarov or TSF circular fixator. Both fixators allowed bone lengthening within reasonable CT and with HI of about 15 days/cm.
References
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25. Pallaro J, Angelliaume A, Dunet B, Lavoinne N, Tournier C, Fabre T. Reconstruction of femoral bone loss with a monoplane external fixator and bone transport. Orthop Traumatol Surg Res. 2015 Sep;101(5):583-7.
26. Henderson DJ, Barron E, Hadland Y, Sharma HK. Functional outcomes after tibial shaft fractures treated using the Taylor spatial frame. J Orthop Trauma. 2015 Feb;29(2):e54-9.
27. Khunda A, Al-Maiyah M, Eardley WG, Montgomery R. The management of tibial fracture non-union using the Taylor Spatial Frame. J Orthop. 2016 Jul;13(4):360-3.
28. Fürmetz J, Soo C, Behrendt W, Thaller PH, Siekmann H, Böhme J. et al. Bone Transport for Limb Reconstruction Following Severe Tibial Fractures. Orthop Rev (Pavia). 2016 Mar;8(1):6384.
29. Aktuglu K, Günay H, Alakbarov J. Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients. Injury. 2016 Dec;47 Suppl 6:S40-S46.
30. Chou PH, Lin HH, Su YP, Chiang CC, Chang MC, Chen CM. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail. J Chin Med Assoc. 2017 Feb 24. pii: S1726-4901(17)30008-4.
31. Menakaya CU, Rigby AS, Hadland Y, Barron E, Sharma H. Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame. Ann R Coll Surg Engl. 2014 Mar;96(2):106-10.
32. Tafazal S, Madan SS, Ali F, Padman M, Swift S, Jones S. et al. Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator. J Child Orthop. 2014 Mar;8(3):273-9.
33. Mayer SW, Hubbard EW, Sun D, Lark RK, Fitch RD. Gradual Deformity Correction in Blount Disease. J Pediatr Orthop. 2016 Dec 23. doi: 10.1097/BPO.0000000000000920.
2. Burg A, Nachum G, Salai M, Haviv B, Heller S, Velkes S. et al. Treating civilian gunshot wounds to the extremities in a level 1 trauma center: our experience and recommendations. Isr Med Assoc J. 2009 Sep;11(9):546-51.
3. Weil YA, Petrov K, Liebergall M, Mintz Y, Mosheiff R. Long bone fractures caused by penetrating injuries in terrorists attacks. J Trauma. 2007 Apr;62(4):909-12.
4. Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K. Outcomes Following Low-Energy Civilian Gunshot Wound Trauma to the Lower Extremities: Results of a Standard Protocol at an Urban Trauma Center. Iowa Orthop J. 2015; 35:65-9.
5. Chimutengwende-Gordon M, Mbogo A, Khan W, Wilkes R. Limb reconstruction after traumatic bone loss. Injury. 2017 Feb; 48(2):206-213.
6. Reitenbach E, Rödl R, Gosheger G, Vogt B, Schiedel F. Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures. Springerplus. 2016 Nov;5(1):2003.
7. O'Neill BJ, Fox CM, Molloy AP, O'hEireamhoin S, Moore DP. The use of circular external fixators in the management of lower limb trauma in Dublin: a single surgeon's 20-year experience. Ir J Med Sci. 2016 Feb;185(1):133-8.
8. Sanchez-Crespo A, Christiansson F, Thur CK, Lundblad H, Sundin A. Predictive value of [18F]-fluoride PET for monitoring bone remodeling in patients with orthopedic conditions treated with a Taylor spatial frame. Eur J Nucl Med Mol Imaging. 2017 Mar;44(3):441-8.
9. Shore BJ, DiMauro JP, Spence DD, Miller PE, Glotzbecker MP, Spencer S. et al. Uniplanar Versus Taylor Spatial Frame External Fixation For Pediatric Diaphyseal Tibia Fractures: A Comparison of Cost and Complications. J Pediatr Orthop. 2015 Dec;36(8):821-8.
10. Kato H, Minami A, Suenaga N, Iwasaki M, Kimura T. Callotasis lengthening in patients with brachymetacarpia. J Pediatr Orthop 2002 Jul-Aug; 22:497–500.
11. Patil MY, Gupta SM, Kurupati SK, Agarwal S, Chandarana V. Definitive Management of Open Tibia Fractures Using Limb Reconstruction System. J Clin Diagn Res. 2016 Jul;10(7):RC01-4.
12. Simons T, Brinck T, Handolin L. Timing of surgical treatment of fractures of multiply iniured patients - from science to tactics. Duodecim. 2016 Jan;132(9):828-35.
13. Barwick TW, Montgomery RJ. Knee arthrodesis with lengthening: experience of using Ilizarov techniques to salvage large asymmetric defects following infected peri-articular fractures. Injury. 2013 Aug;44(8):1043-8.
14. Lowenberg DW, Buntic RF, Buncke GM, Parrett BM. Long-term results and costs of muscle flap coverage with Ilizarov bone transport in lower limb salvage. J Orthop Trauma. 2013 Oct; 27(10):576-81.
15. Robert Rozbruch S, Weitzman AM, Tracey Watson J, Freudigman P, Katz HV. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma. 2006 Mar; 20(3):197-205.
16. Bumbasirevi? M, Tomi? S, Lesi? A, Milosevi? I, Atkinson HD. War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method. Arch Orthop Trauma Surg. 2010 Jun; 130(6):739-49.
17. Wang XG, Wang W, Wang XY, Lü L, Wang GQ, Ma QS, Su GY. One stage treatment of infected tibial defects combined with skin defects with Ilizarov technique. Zhongguo Gu Shang. 2010 Jun; 23(6):422-5.
18. Lin CC, Chen CM, Chiu FY, Su YP, Liu CL, Chen TH. Staged protocol for the treatment of chronic tibial shaft osteomyelitis with Ilizarov's technique followed by the application of intramedullary locked nail. Orthopedics. 2012 Dec;35(12):e1769-74.
19. Yin Q, Sun Z, Gu S, Wei X, Song S, Ma Y. Repair of large tibial bone and soft tissue defects by shortening-lengthening method. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Dec;27(12):1462-5.
20. Yin Q, Sun Z, Gu S, Bao Y, Wei X, Song S. Effectiveness comparison of using bone transport and bone shortening-lengthening for tibial bone and soft tissue defects. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Jul; 28(7):818-22.
21. Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol. 2014 Apr; 24(3):403-8.
22. El-Alfy BS. Unhappy triad in limb reconstruction: Management by Ilizarov method. World J Orthop. 2017 Jan;18;8(1):42-48.
23. Sala F, Elbatrawy Y, Thabet AM, Zayed M, Capitani D. Taylor spatial frame fixation in patients with multiple traumatic injuries: study of 57 long-bone fractures. J Orthop Trauma. 2013 Aug;27(8):442-50.
24. Ajmera A, Verma A, Agrawal M, Jain S, Mukherjee A. Outcome of limb reconstruction system in open tibial diaphyseal fractures. Indian J Orthop. 2015 Jul-Aug;49(4):429-35.
25. Pallaro J, Angelliaume A, Dunet B, Lavoinne N, Tournier C, Fabre T. Reconstruction of femoral bone loss with a monoplane external fixator and bone transport. Orthop Traumatol Surg Res. 2015 Sep;101(5):583-7.
26. Henderson DJ, Barron E, Hadland Y, Sharma HK. Functional outcomes after tibial shaft fractures treated using the Taylor spatial frame. J Orthop Trauma. 2015 Feb;29(2):e54-9.
27. Khunda A, Al-Maiyah M, Eardley WG, Montgomery R. The management of tibial fracture non-union using the Taylor Spatial Frame. J Orthop. 2016 Jul;13(4):360-3.
28. Fürmetz J, Soo C, Behrendt W, Thaller PH, Siekmann H, Böhme J. et al. Bone Transport for Limb Reconstruction Following Severe Tibial Fractures. Orthop Rev (Pavia). 2016 Mar;8(1):6384.
29. Aktuglu K, Günay H, Alakbarov J. Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients. Injury. 2016 Dec;47 Suppl 6:S40-S46.
30. Chou PH, Lin HH, Su YP, Chiang CC, Chang MC, Chen CM. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail. J Chin Med Assoc. 2017 Feb 24. pii: S1726-4901(17)30008-4.
31. Menakaya CU, Rigby AS, Hadland Y, Barron E, Sharma H. Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame. Ann R Coll Surg Engl. 2014 Mar;96(2):106-10.
32. Tafazal S, Madan SS, Ali F, Padman M, Swift S, Jones S. et al. Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator. J Child Orthop. 2014 Mar;8(3):273-9.
33. Mayer SW, Hubbard EW, Sun D, Lark RK, Fitch RD. Gradual Deformity Correction in Blount Disease. J Pediatr Orthop. 2016 Dec 23. doi: 10.1097/BPO.0000000000000920.
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2018-04-09
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Management of Femoral Bone Defect after Gunshot Injury using Circular External Fixator. (2018). Journal of Pakistan Orthopaedic Association, 30(01), 29-38. https://mail.jpoa.org.pk/index.php/upload/article/view/200
