bone transport with tsf s. robert rozbruch, md orthopaedic trauma service director, institute for...
TRANSCRIPT
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Bone Transport Bone Transport with TSFwith TSF
S. Robert Rozbruch, MDS. Robert Rozbruch, MDOrthopaedic Trauma ServiceOrthopaedic Trauma Service
Director, Institute for Director, Institute for Limb Lengthening & ReconstructionLimb Lengthening & Reconstruction
www.LimbLengthening.comwww.LimbLengthening.com
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Problems with classic Ilizarov frame
• Complicated frame application– Need to achieve alignment at surgery– Arched olive wire technique
• Poor control of transport fragment• Docking difficulty
– Mal-alignment– Poor bony contact– Require frame modification
• Deformity of lengthening regenerate
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3 cm
Infected rod, draining sinuses
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equinus
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Infected nonunion3 cm LLD5 cm defectRetained hardwareflaps
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Removal hardwareResect dead boneSquare edgesInsert antibiotic beadsRings first method
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6 weeks laterApply proximal ringEstablish mounting parametersPerform proximal tibia osteotomyRemove beadsBegin transport
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Establish Mounting parameters
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Mounting parameters:intraop
stackingcubes
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Virtual hinge“global positioning”Defined pointRelative to the Reference ring
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MCAOpen grade 3BBone loss
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8 cmdefect
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Control each Segment separately
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BGDockingsite
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Fibula plating Was already Done-prefer not To have them
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Tibia-talar Arthrodesis and Simultaneous tibia lengthening
Bone transport
for segmental tibia defect with osteomyelitis
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Boat explosion
Needs 7.5 cm lengthening and tibio-talar fusion
Infected
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Residual correction
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Ilizarov rods
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15 months
8 cm lengthening
Tibia DiaphysisTo talusfusion
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Bumper injuryParamedic loadingPatient
Grade 3CVascular surgeryFlap coverage
1 year later withDraining sequestrum
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8cm
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Not candidate for another flap
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Trifocal TransportOf bone AndSoft-tissue
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Residual correctionOf recurvatum andLONG
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Apply spatialStrutsWhen thereIs roomTo achieveExcellent alignment
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He hadAn equinuscontracture
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Simultaneous Treatment of Bone Simultaneous Treatment of Bone and Soft-tissue Defects and Soft-tissue Defects
With the Ilizarov MethodWith the Ilizarov Method
S. Robert Rozbruch, MDS. Robert Rozbruch, MDAdam M. Weitzman, BAAdam M. Weitzman, BAJ. Tracey Watson, MDJ. Tracey Watson, MDHoward V. Katz, MDHoward V. Katz, MDPaul Freudigman, MDPaul Freudigman, MDArkady Blyakher, MDArkady Blyakher, MD
www.LimbLengthening.comwww.LimbLengthening.com
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Can the Ilizarov method be used to treat bone and soft-tissue
defects simultaneously without the use of flap coverage?
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Monofocal method
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Bifocal method
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Method
• 25 patients from multiple University Centers
• Not candidates for flap coverage
• Limb salvage undertaking in all cases
• Retrospective review
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Defect size after debridement
• Bone defect: 9.7 cm • (range 2-25)
• Soft-tissue defect: 5.8 cm
• (range 2-14)
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Infections
• Bone infections in 10 patients
• Soft-tissue infections in 16 patients
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Flap Coverage
• 2 patients had previous flap coverage which then had partial necrosis leading to a soft-tissue defect
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Time to closure
• Frame compression: 17 weeks (range 5-39)
• Soft-tissue closure: 14.8 weeks (range 3-41)
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Bone Healing
• Bony union: 24/25 patients
• Bone grafting of docking site in 12 patients
• 3 patients needed a secondary IM nail after frame removal to achieve union.
• One patient has stiff nonunion, is satisfied, and does not want additional treatment
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Time in frame
• 41.5 weeks average (range 10-82)
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Infection
• Infections were cleared in bone and soft-tissue and there were no recurrences
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Lengthening at another site
• 11 patients• Proximal tibia, middle tibia,
fibula, femur• 5.5 cm lengthening • (range 2-11 cm)• Final LLD: 1.4 cm (range 0-5)
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Open femur fx8 cm infected defect6mos after injury
8cm
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8 cm
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LLRS ASAMI-NA• AAOS specialty
day – March 13, 2004– San Francisco, CA
• Annual Meeting– July 23-25, 2004– Toronto, Canada
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Thank You
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Libby Rozbruch
Jason Rozbruch