Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects

Journal of Orthopaedic Surgery, Apr 2007 by Yokoyama, K

To the Editor:

I read with pleasure the article by Magadum et al.1 who treated infected nonunion and large bone defects of the tibia with acute compression and lengthening in 27 men. The largest resection was 17 cm. Functional results were excellent in 19 patients and good in 5. Nonetheless, they should have reported the patients' subjective functional outcomes such as SF-36 scores. Shortening should be evaluated as a percentage of the total length of the tibia. What were the percentage of shortening and the functional outcome of the patient with the largest resection (17 cm)?

We reported 6 patients with type IIIB open tibial fractures treated with primary shortening and limb lengthening.2 The mean shortening was 7.4 (range, 4.5-10.3) cm, which was 18.7% (range, 12.3-29.7%) of the tibia. Functional outcomes according to Puno et al.3 were good in 3 patients, fair in 2, and poor in one. The percentage of shortening in the 2 fair cases was >25%. The median score of physical health summary, mental health summary, and total general health summary based on the SF-36 quality of life questionnaire4 was lower than the standard score in age-matched individuals. We consider that it is difficult to achieve an excellent function and quality of life, especially in patients with shortening of >25% of the tibia.

REFERENCES

1. Magadum MP, Basavaraj Yadav CM, Phaneesha MS, Ramesh LJ. Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects. J Orthop Surg (Hong Kong) 2006;14:273-9.

2. Yokoyama K, Itoman M, Nakamura K, Uchino M, Tsukamoto T, Suzuki T. Primary shortening with secondary limb lengthening for Gustilo IIIB open tibial fractures: a report of six cases. J Trauma 2006;61:172-80.

3. Puno RM, Grossfeld SL, Henry SL, Seligson D, Harkess J, Tsai TM. Functional outcome of patients with salvageable limbs with grades III-B and III-C open fractures of the tibia. Microsurgery 1996;17:167-73.

4. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.

K Yokoyama

Department of Orthopaedic Surgery

Machida Municipal Hospital

Machida, Tokyo, Japan