| Popis: |
Background The purpose of this study was to report on the ease and success of using a solid form-fitting antibiotic cement spacer to manage critical-sized bone defects of the lower extremity. Our hypothesis was that these form fitting spacers will prevent the involution of structures at risk and allow for easy access to the bone defect for secondary bone grafting. Furthermore, antibiotic cement spacers have been demonstrated to form an induced membrane supportive of healing for subsequent bone grafting. Methods Nineteen patients with tibial shaft fractures and two patients with distal femoral fractures with critical-sized bone defects were treated using solid form-fitting antibiotic cement spacers. At the time of definitive closure, a solid form-fitting antibiotic cement spacer was used to fill the defect. After maturity of the coverage, the spacers were removed and replaced with bone graft or bone graft substitute. Results The average defect size was 4cm (2--16cm) and a minimum of 50% of the cortical circumference. The average time to bone grafting was 11 weeks (6--31 weeks). In all patients, a pseudocapsule had formed over the spacer making exposure extremely easy. The spacers prevented involution of muscle, nerves, and vascular structures in all patients. Conclusions The use of a solid form-fitting antibiotic cement spacer to prevent involution of muscle and neurovascular structures to defects eased bone-grafting procedures and is recommended. No soft-tissue coverage difficulties occurred after extensive grafting. The pseudocapsule facilitated secondary bone grafting, and all defects treated with autogenous cancellous graft healed. |
