One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaohui ,  GAO Junqing , ZHAN Xiaohuan , HUANG Zhaohua , ZHANG Jiasheng

Department of Reparative and Reconstructive Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan Guangdong, 528000, P.R.China;

Corresponding?author：

GAO Junqing, Email: gao-7950@163.com

Keywords：

Lateral malleolus defect; debridement; Ilizarov bone transport technology; fibula osteotomy

DOI：

10.7507/1002-1892.201901091

Video：

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Objective To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.

Citation： WANG Zhaohui, GAO Junqing, ZHAN Xiaohuan, HUANG Zhaohua, ZHANG Jiasheng. One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 865-870. doi: 10.7507/1002-1892.201901091 Copy

1.	Debnath UK, Maripuri SN, Guha AR, et al. Open grade Ⅲ " floating ankle” injuries: a report of eight cases with review of literature. Arch Orthop Trauma Surg, 2007, 127(8): 625-631.
2.	杜全紅, 史永安, 叢海波, 等. 游離髂骨移植重建外踝的臨床研究. 中華創傷骨科雜志, 2016, 18(6): 493-497.
3.	胡灃, 趙光勛, 方健, 等. 帶蒂腓骨頭瓣聯合腓淺神經營養皮瓣修復兒童外踝骨及軟組織缺損. 中華顯微外科雜志, 2017, 40(2): 139-141.
4.	任義軍, 嚴立, 胡銳, 等. Ilizarov技術在治療脛骨骨與軟組織缺損中的應用. 中華創傷骨科雜志, 2017, 19(3): 213-218.
5.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot ankle Int, 1994, 15(7): 349-353.
6.	Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, et al. Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res, 2005, (437): 209-218.
7.	韋健, 容安, 周建飛, 等. 腓骨延長術治療外踝開放性骨缺損. 中醫正骨, 2016, 28(10): 62-63.
8.	俞立新, 高建明, 吳水培, 等. 帶血管蒂第二跖骨底骨瓣移位修復外踝骨缺損. 中國修復重建外科雜志, 2002, 16(2): 117-119.
9.	武勇, 賴良鵬, 王巖, 等. 全踝關節置換治療終末期踝關節炎療效分析. 中華骨科雜志, 2015, 35(7): 699-706.
10.	詹曉歡, 陳元榮, 羅樺杰, 等. Gustilo ⅢB和ⅢC型骨折治療進展. 中華顯微外科雜志, 2018, 41(3): 310-312.
11.	Laible C, Earl-Royal E, Davidovitch R, et al. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem? J Orthop Trauma, 2012, 26(2): 92-97.
12.	秦泗河, 焦紹鋒, 潘奇. Ilizarov技術結合游離皮瓣移植治療創傷后重度馬蹄足畸形伴跟骨缺損一例. 中華創傷骨科雜志, 2013, 15(10): 919-920.
13.	張磊, 王新衛, 陳雨聲, 等. 應用Ilizarov技術治療骨髓炎出現復雜軟組織問題的處理技巧探討. 中國修復重建外科雜志, 2018, 32(10): 1286-1291.
14.	尚大財, 劉欽林, 鐘生財, 等. Ilizarov骨滑移技術治療四肢長骨創傷性骨髓炎的臨床研究. 中國矯形外科雜志, 2016, 24(3): 220-225.
15.	高堪達, 王秋根, 黃建華, 等. 骨搬運技術在下肢創傷后感染性骨缺損治療中的應用. 中華創傷骨科雜志, 2009, 11(10): 985-987.
16.	鄒宇煒, 楊新明, 蘇峰, 等. 外踝長度短縮時踝關節應力改變的研究. 中國臨床解剖學雜志, 2005, 23(6): 661-663.
17.	Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury, 2010, 41(2): 128-132.
18.	滕星, 黃雷, 楊勝松, 等. 應用混合式外固定支架骨搬運技術治療脛骨干骺端骨缺損. 中華創傷骨科雜志, 2013, 15(10): 834-839.
19.	Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma, 2003, 17(7): 503-507.
20.	Britten S, Ghoz A, Duffield B, et al. Ilizarov fixator pin site care: the role of crusts in the prevention of infection. Injury, 2013, 44(10): 1275-1278.
21.	成亮, 徐佳, 柴益民, 等. 單邊外固定支架與環形外固定支架骨搬運治療下肢長干骨缺損的療效及并發癥比較. 中華創傷骨科雜志, 2015, 17(10): 863-867.

1. Debnath UK, Maripuri SN, Guha AR, et al. Open grade Ⅲ " floating ankle” injuries: a report of eight cases with review of literature. Arch Orthop Trauma Surg, 2007, 127(8): 625-631.
2. 杜全紅, 史永安, 叢海波, 等. 游離髂骨移植重建外踝的臨床研究. 中華創傷骨科雜志, 2016, 18(6): 493-497.
3. 胡灃, 趙光勛, 方健, 等. 帶蒂腓骨頭瓣聯合腓淺神經營養皮瓣修復兒童外踝骨及軟組織缺損. 中華顯微外科雜志, 2017, 40(2): 139-141.
4. 任義軍, 嚴立, 胡銳, 等. Ilizarov技術在治療脛骨骨與軟組織缺損中的應用. 中華創傷骨科雜志, 2017, 19(3): 213-218.
5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot ankle Int, 1994, 15(7): 349-353.
6. Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, et al. Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res, 2005, (437): 209-218.
7. 韋健, 容安, 周建飛, 等. 腓骨延長術治療外踝開放性骨缺損. 中醫正骨, 2016, 28(10): 62-63.
8. 俞立新, 高建明, 吳水培, 等. 帶血管蒂第二跖骨底骨瓣移位修復外踝骨缺損. 中國修復重建外科雜志, 2002, 16(2): 117-119.
9. 武勇, 賴良鵬, 王巖, 等. 全踝關節置換治療終末期踝關節炎療效分析. 中華骨科雜志, 2015, 35(7): 699-706.
10. 詹曉歡, 陳元榮, 羅樺杰, 等. Gustilo ⅢB和ⅢC型骨折治療進展. 中華顯微外科雜志, 2018, 41(3): 310-312.
11. Laible C, Earl-Royal E, Davidovitch R, et al. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem? J Orthop Trauma, 2012, 26(2): 92-97.
12. 秦泗河, 焦紹鋒, 潘奇. Ilizarov技術結合游離皮瓣移植治療創傷后重度馬蹄足畸形伴跟骨缺損一例. 中華創傷骨科雜志, 2013, 15(10): 919-920.
13. 張磊, 王新衛, 陳雨聲, 等. 應用Ilizarov技術治療骨髓炎出現復雜軟組織問題的處理技巧探討. 中國修復重建外科雜志, 2018, 32(10): 1286-1291.
14. 尚大財, 劉欽林, 鐘生財, 等. Ilizarov骨滑移技術治療四肢長骨創傷性骨髓炎的臨床研究. 中國矯形外科雜志, 2016, 24(3): 220-225.
15. 高堪達, 王秋根, 黃建華, 等. 骨搬運技術在下肢創傷后感染性骨缺損治療中的應用. 中華創傷骨科雜志, 2009, 11(10): 985-987.
16. 鄒宇煒, 楊新明, 蘇峰, 等. 外踝長度短縮時踝關節應力改變的研究. 中國臨床解剖學雜志, 2005, 23(6): 661-663.
17. Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury, 2010, 41(2): 128-132.
18. 滕星, 黃雷, 楊勝松, 等. 應用混合式外固定支架骨搬運技術治療脛骨干骺端骨缺損. 中華創傷骨科雜志, 2013, 15(10): 834-839.
19. Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma, 2003, 17(7): 503-507.
20. Britten S, Ghoz A, Duffield B, et al. Ilizarov fixator pin site care: the role of crusts in the prevention of infection. Injury, 2013, 44(10): 1275-1278.
21. 成亮, 徐佳, 柴益民, 等. 單邊外固定支架與環形外固定支架骨搬運治療下肢長干骨缺損的療效及并發癥比較. 中華創傷骨科雜志, 2015, 17(10): 863-867.

Chinese Journal of Reparative and Reconstructive Surgery

One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect

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