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.
Copyright 2011, SLACK Incorporated.