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TITLE:

STUDY TO KNOW TREATMENT OF INFECTED NON-UNION TIBIA BY INTERCALARY BONE TRANSPORT

AUTHORS:

Dr Inam Ullah Khan, Dr Farid Ullah Khan Zimri, Dr Saeed Ahmad, Prof. Rizwan Hameed Malik ,Prof. Imran Sikandar Khan, Dr Syed Shujaat Ali Shah

ABSTRACT:

Abstract: Objective: To evaluate the efficacy of Ilizarov ring fixator with intercalary bone transport in the infected non-union tibia treatment. Study Design: A quasi-experimental study. Place and Duration: In the Orthopaedic department of Capital Hospital Islamabad for two-year duration from March 2017 to March 2019. Methodology: Sixteen patients with non-unionized infected tibia (type IV osteomyelitis Lax / Cierney), all male and age range of 20-60 years with 32 years mean age; The most common cause was open fracture and the most common site was lower 1/3. In infected tibia with sinus drainage, a wound smear was performed for sensitivity and culture and a sinogram was performed. Sequestrectomy and debridement were performed leaving gap between 2 and 8 cm (mean 4.5 cm) and Ilizarov ring fixator. A navigation cable was passed through the medial malleolus, the irrigation system was installed, and the wound was sealed in a one layer. A proximal metaphysical corticotomy was performed. For five days, normal saline of two to three litters and irrigation with proper antibiotics were started. On the fifth day, the removal of irrigation system was done, and transport began. Patients endured partially loaded until soft tissue healing occurred. Transport was carried out at a speed of 1 mm / day with the navigation cable until the coupling was achieved. After healing of soft tissues, it allowed to support all weight; Physiotherapy of the ankle and knee started from the first day. After 2-3 weeks of coupling; navigation cable was disconnected. 12 to 27 months was the follow-up time with 16 months mean. Results: In each case, the union was achieved during the removal of the frame, ie between 8-13 months. The union duration at the site of placement ranged from 3.5 months to 6 months with 4.5 months mean. The bone grafting required in 2 patients at the insertion site. In a regenerated state, it was broken due to the plaster-treated fall. All subjects were gratified except one 60-year-old patient with knee osteoarthritis in severe stage. In all patients; Pin tract infection occurred and was inactivated by proper antibiotics. Infection was reduced in all cases except two cases who underwent local flap debridement. Conclusion: Intercalary bone transplantation with the Ilizarov ring fixator is the preferred treatment for non-union of the loose and infected tibia without discrepancy in the length of the leg. Key Words: Ilizarov ring fixator, infection, non-unionized tibia, navigation cable, external fixator.

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