Nailing treatment in bone transport complications

Area of Science:

• Orthopedic surgery
• Regenerative medicine
• Bone healing

Background:

• Bone transport is utilized for significant bone defects resulting from trauma or infection.
• Complications such as insufficient regenerate bone thickness and docking site nonunion can occur after external fixation.
• Refracture of regenerated bone is a risk, particularly with inadequate cortical wall thickness.

Purpose of the Study:

• To evaluate the efficacy of reamed intramedullary nailing in managing complications of regenerated bone and docking sites after bone transport.
• To assess union rates, corticalization, and complication incidence following nailing in this patient cohort.

Main Methods:

• A series of nine patients (5 femur, 4 tibia) with bone transport complications underwent reamed intramedullary nailing.
• Patients had prior resection for open fractures or infection, followed by bone transport using external fixators.
• Follow-up included clinical and radiographic assessments for union, corticalization, and infection.

Main Results:

• All nine patients achieved union and complete corticalization of the regenerate column within an average of 6 months post-nailing.
• Six patients had insufficient cortical wall thickness of the regenerate, with two experiencing docking site nonunion.
• One patient developed a deep infection 4 months after nailing, successfully treated with antibiotics and nail removal.

Conclusions:

• Reamed intramedullary nailing presents a viable solution for addressing regenerated bone and docking site issues post-bone transport.
• Prolonged external fixation prior to nailing may increase the risk of infection, potentially necessitating prophylactic or early antibiotic treatment.