Infected Segmental Defect Pseudarthrosis of the Tibia

Abstract

Objective:

The purpose of this study was to evaluate a consequent and protocolized approach of infected segmental defect pseudarthrosis of the tibia.

Patients and Methods:

During the period 1993–2000, we treated 18 patients for infected tibial pseudarthrosis with additional segmental bone loss. The method of bone reconstruction was chosen depending on the size of the segmental defect and other factors such as condition of the soft tissues and the patient’s age. The following treatment procedures were performed: primary shortening (five patients), one or more cancellous bone grafting procedures to bridge the skeletal defect (nine patients), bone segment transport according to Ilizarov (three patients), and free vascularized transplantation of the contralateral fibula (one patient). The number of complications, operative procedures and hospital admissions differed between the four patient groups with different bone defect reconstructions, however, the differences were not significant.

Results:

In twelve patients, limb salvage was successful. Most of these patients had no or little limitations in daily life and returned to work. The mean lower extremity impairment score was 13% (range: 0–43%). Six patients underwent amputation, due to various reasons.

Conclusions:

The problem of infected tibial pseudarthrosis with segmental bone loss remains important despite advances in diagnostics and management. If limb salvage is successful, the ultimate functional outcome will be good in the majority of cases. In selected cases, amputation is still indicated.