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EDITORIAL
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 68

Infected nonunion of the long bones


Professor and Chairman of the Orthopaedic Department, Benha University Hospitals, Benha, Egypt

Date of Web Publication16-Sep-2016

Correspondence Address:
Gamal Ahmed Hosny
11, Israa, Al Mohandeseen, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3719.190705

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How to cite this article:
Hosny GA. Infected nonunion of the long bones. J Limb Lengthen Reconstr 2016;2:68

How to cite this URL:
Hosny GA. Infected nonunion of the long bones. J Limb Lengthen Reconstr [serial online] 2016 [cited 2019 Oct 23];2:68. Available from: http://www.jlimblengthrecon.org/text.asp?2016/2/2/68/190705




My long journey with Ilizarov started in 1983 during my residency in Benha University Hospitals in Egypt. Then, I furthered my training in that field in many centers in Europe, after more than 30 years' experience, I have realized that Ilizarov method has dramatically changed the course of many challenging situations in orthopedic surgery as the management of infected nonunion which was once an indication for amputation.

Infected nonunion of the long bones is a complicated problem. The presence of bone gap, deformity, joint stiffness discharging sinuses, soft tissue defect, scars from previous operation, and disuse osteoporosis renders conventional treatment more difficult. For decades, different modalities of surgical treatment including bone grafts, multiple debridements, internal fixation, and unilateral external fixators had been applied with limited success rate and numerous complications. It was logical to discuss amputation with the patients as one of the treatment options. With the advent of Ilizarov principles, the results of management have changed dramatically. These principles include the law of tension stress and the infection burns in the fire of regeneration. Soft tissue defects could be handled with rotational flaps, microsurgical free flaps, cross leg flaps, and finally Ilizarov skin traction. Recently, the addition of biologics as stem cells has enhanced the regenerate formation and decreased the fixator time. The incidence of infected nonunion is unknown, but it seems rather high in the Middle East countries. In the countries with limited resources, staged treatment poses a real financial problem. This was the reason behind the adoption of our philosophy of one stage treatment in most cases. The operation starts with covering of the infected part, applying the frame to the healthy part of bone, and doing corticotomy, then this part is covered completely and isolated to avoid contamination, followed by debridement and removal of the sequestrum. Any plastic operation to cover the defect has to be performed at the same time before completion of frame application. In some selected cases, gradual fibular transfer and the bloodless technique were used. Radical resection of the infected area had been described as the key of success. However, we only resect the sequestrum or the dead bone and we keep the infected vascularized bone ends. Compression distraction techniques are effective to get rid of infection and induce union in these cases.

After treating hundreds of cases, we can conclude that Ilizarov method is a real breakthrough in the history of management of infected nonunion of long bones with remarkable success rates and few complications.




 

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