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Methods to shorten the duration of an external fixator in the management of tibial infections

查看全文 作　　者：Khaled M [1]Emara;Khaled Abd Al [2]Ghafar;Mohamed Ahmed Al [3]Kersh 高影响力作者 机构地区：[1]Orthopaedic Surgery,Ain Shams University Hospitals,Cairo 0020,Egypt;[2]Lecturer in Orthopaedic Surgery,Ain Shams University,Cairo 0020,Egypt;[3]Assistant Lecturer of Orthopaedic Surgery,Ain Shams University,Cairo 0020,Egypt高影响力机构 出　　处：《World Journal of Orthopedics》索引2011年第2卷第9期,共8页高影响力期刊 摘　　要：Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening condition.The only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis;yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss,is the long duration of the fixator.In addition to autologous bone grafting,several mechanical,biologic,and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis patients.Mechanical approaches include compressive loading of the distraction regenerate,increased frequency of small increments of distraction,and compression-distraction.Intramedullary nailing and hemicorticotomy can reduce the time in external fixation;however,these techniques are associated with technical difficulties and complications.Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation.Other promising modalities include diphosphonates,physician-directed use(off-label use)of bone morphogenetic proteins,and local injection of bone marrow aspirate and platelet gel at the osteotomy site.Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer. 关 键 词：Ilizarov Bone infection INTRAMEDULLARY NAIL Hemicorticotomy Tibiofibular SYNOSTOSIS FIBULAR transport
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