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Trauma: C. Sen, L. Eralp, T. Gunes, M. Erdem, V. E. Ozden, and M. Kocaoglu An alternative method for the treatment of nonunion of the tibia with bone loss J Bone Joint Surg Br 2006; 88-B: 783-789 [Abstract] [Full text] [PDF]

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An alternative method for the treatment of nonunion of the tibia with bone loss

Mahmoud A. El-Rosasy   (6 July 2006)

An alternative method for the treatment of nonunion of the tibia with bone loss 6 July 2006
Mahmoud A. El-Rosasy, Lecturer of Othopaedic Surgery Faculty of Medicine - University of Tanta - Egypt Send letter to journal: Re: An alternative method for the treatment of nonunion of the tibia with bone loss elrosasym{at}yahoo.com Mahmoud A. El-Rosasy	Sir, I read this article with interest, however, I am concerned about several points. Firstly, the technique as described increases the treatment time and cost by adding a surgical manoeuvre for debridement before definitive reconstruction. This staged reconstruction would be acceptable if internal fixation was being used. The Ilizarov technique has been used for one stage reconstruction even in the presence of active infection, owing to the ability to excise devitalised tissue and distraction histogenesis.1,2 Secondly, figure 1 shows a nice longitudinal approach to the tibia for first stage debridement. In the text the authors mentioned that they used a transverse skin incision for the second stage. This means that the incisions cross each other with further soft tissue compromise. On the other hand, such a transverse incision may not be suitable for 4 cm of acute shortening and the Z-plasty technique should be considered.3 Thirdly, figure 2 shows what seems to be a hypertrophic nonunion of the tibia, despite the assertion that all patients had atrophic nonunion. Moreover, the post-operative radiographs are not included to show how this patient was treated, and figures 3a and 3b did not really contribute to the paper. Lastly, the authors mentioned that they used 750 mg of ciprofloxacin twice daily for the treatment of pin track infection. Is there any reason to use ciprofloxacin bearing in mind its inhibitory effect on bone healing? Case number 16 is a skeletally immature patient (age 10 years); was this antibiotic also used in this case for pin track infection?4,5 M.A. EL-ROSASY, Lecturer in Orthopaedic Surgery, University of Tanta, Egypt. 1. Saleh M, Rees A. Bifocal surgery for deformity and bone loss after lower-limb fractures. Comparison of bone-transport and compression-distraction methods. J Bone Joint Surg [Br] 1995;77-B:429-34. 2. Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA. Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury 2005;36:662-8. 3. Simpson AH, Andrews C, Giele H. Skin closure after acute shortening. J Bone Joint Surg [Br] 2001;83-B:668-71. 4. Holtom PD, Pavkovic SA, Bravos PD, et al. Inhibitory effects of the quinolone antibiotics trovafloxacin, ciprofloxacin, and levofloxacin on osteoblastic cells in vitro. J Orthop Res 2000;18:721-7. 5. Huddleston PM, Steckelberg JM, Hanssen AD, et al. Ciprofloxacin inhibition of experimental fracture healing. J Bone Joint Surg [Am] 2000;82-A:161-73.