Utilization of medial fibular struts following femoral ...llrs.org/PDFs/Annual Meeting Presentations/Friday Meeting/10.Balci.pdf%35 of the femur •Mean follow up ... •One sequela

1, Istanbul Medical Faculty, Department of Orthopedics and Traumatology, Istanbul

2 Memorial Hospital Sisli, Department of Orthopedics and Traumatology, Istanbul

09.08.2013 1

Limb Lengthening and Reconstruction Society 23th Annual Scientific Meeting

New York

Utilization of medial fibular struts following femoral lengthening through a proximal

osteotomy

Balci Halil1, Kocaoğlu Mehmet2, Eralp Levent 1, Kapıcıoğlu Mehmet 1

All Authors

We have no potential conflicts

with this presentation.

8/9/2013 2

• Type 4 Osteomyelitis of the femur is a challenging treatment

• After the infected segment resection, antibiotic cement application

• We have mega-defect for the reconstruction

Ö.Ç 34.M. OSTEOMYELİTİS +SHORTENİNG + DEFECT AFTER THE DEBRİDMENT

• Bone grafting

• Transfer of vascularised free fibula

• External fixation, Ilizarov principles:

Bifocal compression distraction

Acute shortening and lengthening

Bone transport (bone loss > 7 cm)

Combined techniques Shorten EFI Prevents deformity and shortening Increase patients comfort

• We reconstruct the defect with segment transport over the I.M. Nail in selected patients. (combined technique)

TECHNIQUE

After the end of the transport, if we do not visualize a good quality of regenerate

The insufficiency of the regenerate

Challenge

we lock the intramedullary nail, remove the external fixator.

we augment the regenerate with non vascularized fibular autograft

Regenerate tissue around the nail with longitudinal incision

non vascularized autologous fibular greft

Post operative 2. years

METHOD

• 6 patients (3F,3M)

• Mean age 52 years (37-72).

• The mean segmental transport amount was %35 of the femur

• Mean follow up 84 months,

• Mean defect size + shortening 13 cm

• Mean length of fibular graft 15,3 cm

• The mean bone healing index 0,76 months/ cm.

• All of the patients had good consolidation at distraction side

• Two docking side non union.

RESULTS

Complications

• 3 problems • 4 obstacles 2 docking side nonunions One broken nail One pts. decreased knee

ROM • One sequela (collum femoris

fracture) not related with this technique, Related with segment transport

*Paley classification (Clin Orthop 1990; 250:81-104)

Paley’s Bone Score

• 4 excellent

• one good

• one fair

• 4 excellent

• One good

• One fair

Paley’s functional score

Free vascularised fibular greft is widely used source of viable bone for covering bone defects larger than 6 -8 cm with two staged treatment

Microsurgical intervation

Why Fibular autograft application ?

• Osteoconductive and osteoinductive (adjuvant cancellous greft )

• Augment the regenerate

• Decrease the consolidation period

• Mechanical support between proximal and distal parts of the defect with its cortical structure.

• Early controlled weight bearing that stimulate the regenerate

• No complication related to donor side

H.K.

H.K.47 Y F. Shortening and infected nonunion

H.K.47Y F. Debridment, segment resection with transverse incision + antibiotic impregnated rod and sement application

After the segment transport equalization of LLD

H.K

• The mechanichal axis pass from the medial side

• Long cylindrical straigth shape provide mechanical strength

• It absorbs the compressive force and prevents the failure of the construct during consolidation.

• Induced membrane concept as proposed by Masquelet ?

• Creeping substitution ?

• Both?

Consolidation of non vascularised fibular autograft

Conclusion

• Fibular autograft application provides not only osteoconductive and osteoinductive properties

• It augments the regenerate

• Decrease the consolidation period,

• Mechanical support between proximal and distal part of the defect with its cortical structure.

THANK YOU FOR YOUR ATTENTION