Locking Compression Plate as an External Fixator for the Treatment of Tibia Infected Bone Defects

Abstract

Purpose This study was designed to observe the medium-term efficacy of an induced membrane technique combined with a locking compression plate as an external fixator for the treatment of tibia infected bone defects.

Methods Patients with a tibial infection were admitted to our department between January 2013 and November 2014. All patients were treated with the induced membrane technique. In the first stage, polymethyl methacrylate (PMMA) cement was implanted in the defects after debridement and then fixed with a locking compression plate (LCP) as an external fixator. In the second stage, bone grafts were implanted to rebuild the defects. The external plates were replaced with nails in 57 patients (internal group), and the remaining 30 patients were not exchanged with fixation (external group). The infection control rate, bone union rate, and complications of the two groups were compared.

Results Eighty-seven patients were enrolled in this study, and all patients had a minimum follow-up of 5 years (average 62.8 months) after grafting. Eighty-three patients (95.4%) achieved bone union, and the average union time was 6.77 months. Five patients (5.7%) experienced recurrence of infection. Complications included pin tract infection, fixation loosening, deformity connection, and limitation of joint range of motion (ROM). No significant differences in the infection control rate or bone defect union rate were noted between the two groups. The overall rate of complications in the external group was 50%, which was greater than that noted in the internal group (21.1%).

Conclusions Locking compression plates are external fixators with smaller sizes that are easier to operate than conventional annular fixators or assembled external fixators. The use of locking compression plates in combination with the induced membrane technique in the treatment of tibia infected bone defects can achieve good clinical efficacy after medium-term follow-up.

Zusammenfassung

Ziele Ziel dieser Studie war es, die mittelfristige Wirksamkeit einer induzierten Membrantechnik in Kombination mit einer winkelstabilen Kompressionsplatte als Fixateur externe zur Behandlung von Knochendefekten nach Tibiainfektion zu untersuchen.

Methoden: Patienten mit Tibiainfektion wurden zwischen Januar 2013 und November 2014 in unsere Abteilung aufgenommen. Alle Patienten wurden mit der induzierten Membrantechnik behandelt. Im 1. Schritt wurde Polymethylmethacrylat-(PMMA-)Zement in die Defekte nach dem Débridement implantiert und anschließend mit einer winkelstabilen Kompressionsplatte (LCP) als Fixateur externe fixiert. Im 2. Schritt wurden Knochentransplantate implantiert, um die Defekte wieder aufzubauen. Bei 57 Patienten (interne Gruppe) wurden die externen Platten durch Nägel ersetzt, und die restlichen 30 Patienten wurden nicht mit Fixation ausgetauscht (externe Gruppe). Die Infektionskontrollrate, Knochenvereinigungsrate und Komplikationen der beiden Gruppen wurden verglichen.

Ergebnisse In diese Studie wurden 77 Patienten eingeschlossen, und alle Patienten hatten eine Nachbeobachtungszeit von mindestens 5 Jahren (durchschnittlich 62,8 Monate) nach der Transplantation. 83 Patienten (95,4%) erreichten eine Knochenvereinigung und die durchschnittliche Verbindungsdauer betrug 6,77 Monate. Bei 5 Patienten (5,7%) kam es zu einem erneuten Auftreten der Infektion. Komplikationen sind Pin-Trakt-Infektion, Lockerung der Fixierung, Deformitätsverbindung und Einschränkung der Gelenkbeweglichkeit (ROM). Zwischen beiden Gruppen wurden keine signifikanten Unterschiede in der Infektionskontrollrate oder der Knochendefekt-Unionsrate festgestellt. Die Gesamtkomplikationsrate in der externen Gruppe betrug 50% und war damit höher als in der internen Gruppe (21,1%).

Schlussfolgerungen Verriegelnde Kompressionsplatten sind externe Fixateure mit kleineren Größen, die einfacher zu bedienen sind als herkömmliche ringförmige Fixateure oder zusammengebaute externe Fixateure. Der Einsatz von winkelstabilen Kompressionsplatten in Kombination mit der induzierten Membrantechnik bei der Behandlung von tibiainfizierten Knochendefekten kann nach mittelfristiger Nachbeobachtung eine gute klinische Wirksamkeit erreichen.

Key words

induced membrane - external fixation - infected bone defects - locking compression plate

Schlüsselwörter

Membran - Kompressionsplatte verriegeln - externe Fixierung - infizierte Knochendefekte

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