Management of combined bone defect and limb-length discrepancy after tibial chronic osteomyelitis

Bone defects and leg shortening due to chronic osteomyelitis are rare yet challenging problems to treat. The aim of this study was to summarize our experience with a distraction osteogenesis technique performed with an external fixator for these conditions. Twenty-three consecutive patients with tibial bone defects and limb-length discrepancy caused by osteomyelitis were treated from January 1994 to January 2009. Thirteen boys and 10 girls had a mean age of 12.2 years (range, 8-16 years). Twenty of the 23 patients (87.0%) had undergone an unsuccessful bone grafting procedure. Mean amount of bone defect was 3.6 cm (range, 1.5-6.2 cm) as measured on plain radiographs. Mean leg-length discrepancy was 4.0 cm (range, 0-8.0 cm). All patients were followed for a mean of 116 months (range, 31-182 months). Mean external fixation index was 48.0 days/cm (range, 40.7-66.5 days/cm). Mean lengthening was 9.3 cm (range, 5.8-12.1 cm). Based on the criteria recommended by Paley et al, 16 bone results were excellent, 6 good, and 1 fair. Fifteen functional results were excellent, 7 good, 1 fair, and 0 poor. This study shows that distraction osteogenesis with an external fixator is an effective treatment for massive postosteomyelitis bone defects and leg shortening.