Clinical research of Ilizarov technique for treatment of lower limb infected bone defect

Objective To explore the clinical efficacy of Ilizarov technique for infected-bone defect in lower extremity. Methods From January 2013 to December 2016, data of 31 consecutive patients with lower limb infected bone defect were retro-spectively analyzed. There were 23 males and 8 females, with an average age of 35.8 years (range, 5-57 years). 16 cases of infect-ed bone defect were on femur while the other 15 were on tibia. The infected bone defects were developed from blood-borne osteo-myelitis in 3 cases, from open fracture (according to Gustlio classification, Gustilo Ⅱ 8, Ⅲa 5, Ⅲb 4) surgery in 17 cases (12 cas-es after external fixation and 5 cases after internal fixation), and from closed fracture surgery of plate or intramedullary nail fixation in 11 cases. Soft-tissue defects were observed in 5 cases, including 1 femur and 4 tibia. The previous operations were performed with an average operation time of 3.2 (range, 2-5 times) and treatment duration of 9.6 months (range, 3-21 months). The operation process was one stage debridement, external fixation, combined with bone osteotomy and transportation. Bone transportation start-ed 7 to 10 days after osteotomy with a speed of 1 mm/d, and 0.25 mm/time. Healing rate and complications were recorded during the follow-up period and were assessed by Paley fracture healing score. Results The length of bone defect after debridement was 6.9 cm (range, 3-13.5 cm). There were 27 cases positive in bacterial culture, who were treated by sensitive antibiotics. The other 4 cases were negative and treated by broad-spectrum antibiotics. The bone lengthening speed was 0.76 mm/d (range, 0.56-0.86 mm/d). All bone and soft-tissue defects healed, with average bone healing time of 11.5 months (range, 6-18.5 months). All patients were followed-up for 12 to 48 months (average, 25.5 months). Pin infection appeared in 11 cases (8 cases on femur and 3 cases on tibia) who were cured by oral antibiotics, serial dressing and debridement. Axial displacement was presented in 4 cases on femur and were corrected by external fixation adjustment. No recurrent infection was observed and the limb length restored normal. Postoper-ative complications in femur were 106.3% (17/16) comparing 46.7% (7/15) in tibia. According to Paley fracture healing score, 12 cases were excellent, 14 were good and 5 were fair, yielding an excellent to good rate of 83.9% (26/31). Conclusion Ilizarov tech-nique is an effective way in the treatment of infected-bone defects. The complication rates on femur observed in this study were slightly higher than that on tibia. Key words: Ilizarov technique; Femur; Tibia; Infection