Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing

Ferreira, Wladimir Querubino; Ferreira, Dwilian José; Fontoura, Ricardo Stival; Peres, João Vieira; Rocha, Danilo Simões; Lima, João Pedro Leite

doi:10.1055/s-0043-1770974

Accessibility / Report Error

Brazil

Revista Brasileira de Ortopedia

Português Español

Brazil

Português Español

table of contents « previous current next »

Table of contents

Original Article • Rev bras ortop 58 (4) • Jul-Aug 2023 • https://doi.org/10.1055/s-0043-1770974 copy

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing.

Methods

Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test.

Results

Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated.

Conclusions

The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Keywords
Ilizarov technique; pseudoarthrosis; tibia; treatment outcome

Bone outcomes	Bone consolidation	Lack of infection	Angular deformity lower than 7°	Tibial length discrepancy lower than 2.5 cm
Excellent	All above criteria
Good	Bone consolidation plus two other criteria
Regular	Bone consolidation plus one other criterion
Poor	No bone consolidation, refracture, or lack of any other criterion

Functional outcomes	Significant claudication	Equinus deformity	Soft tissue dystrophia	Pain and inactivity
Excellent	Active subject with none of the four criteria
Good	Active subject with one or two criteria
Regular	Active subject with three or four criteria
Poor	Inactive subject regardless of other criteria

General features		Frequency	χ²
Categories	n = 43	%	p-value
Age range			0.8610
20 to 29 years	7	16.3
30 to 39 years	9	20.9
40 to 49 years	7	16.3
50 to 59 years	11	25.6
60 years or older	9	20.9
Gender			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Female	6	14.0
Male	37	86.0
Reason for trauma			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Firearm	2	4.7
Hit and run	3	7.0
Motorcycle accident	16	37.2
Fall from own height	1	2.3
Not specified	21	48.8
Laterality			0.7604
Right	20	46.5
Left	23	53.5

Treatment and complications		Frequency	χ²
Feature	n = 43	%	p-value
Treatment time (months)			0.0063 ^* * Chi-square test for adherence to equal expected proportions.
11 months or less	9	20.9
12 to 23 months	19	44.2
24 to 35 months	12	27.9
36 months or more	3	7.0
Type of treatment			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Bifocal	20	46.5
Trifocal	20	46.5
Tetrafocal	2	4.7
Tibialization of the fibula	1	2.3
Complication			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Regenerating tissue fracture	2	4.7
Osteolysis/pin loosening	1	2.3
Pin path infection	38	88.3
Refracture	2	4.7

Functional outcomes assessment		Frequency	χ²
Features	n = 43	%	p-value
Claudication			0.3602
Yes	18	41.9
No	25	58.1
Equinus deformity			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Yes	5	11.6
No	38	88.4
Dystrophia			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Yes	2	4.7
No	41	95.3
Pain/inactivity			<0.0001 ^* * Chi-square test for adherence to equal expected proportions.
Yes	4	9.3
No	39	90.7
Discrepancy lower than 1.5 cm			0.0008 ^* * Chi-square test for adherence to equal expected proportions.
Yes	33	76.7
No	10	23.3

			Treatment time (months)
		n	Average	Standard deviation	p-value
Reason for trauma					0.2876
	Firearm	2	16.0	14.1
	Hit and run	3	23.7	4.0
	Fall from motorcycle	16	19.3	12.8
	Fall from own height	1	25.0	—
	Not specified	21	20.9	8.9
Type of treatment					0.0100 ^* * Student's t-test (Bifocal x Trifocal)
	Bifocal	20	15.6	6.4
	Trifocal	20	23.8	11.6
	Tetrafocal	2	33.5	2.1
	Tibialization of the fibula	1	21.0	—
Claudication					0.0469 ^ Student's t-test (Claudication x No claudication)
	Yes	18	24.2	12.1
	No	25	17.6	7.6
Equinus deformity					0.4272
	Yes	5	23.8	10.7
	No	38	19.9	10.2
Dystrophia					n/a
	Yes	2	37.0	2.8
	No	42	19.5	9.7
Pain/inactivity					0.1509
	Yes	4	37.3	19.3
	No	39	18.6	7.2

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Stay informed of issues for this journal through your RSS reader

[1] Address for correspondence João Pedro Leite Lima, Resident Physician in Orthopedics and Traumatology, Hospital Regional de Sobradinho, endereço: Quadra 12 Conjuto B Lote 38 Sobradinho, DF, 73010-120, Brasil. (e-mail: joaopedroleitelima@hotmail.com).