THE VALUE OF INTRAMEDULLARY REAMING AND S PLINTING IN THE TREATMENT OF INFECTED PSEUDOARTHROSIS

In the treatment of pseudarthrosis with only a segmental loss of bone elements a reconstruction by the Ilizarov method is too complicated, a nd simple decortication and plastic surgery with cancellous bone graft ing is usually too slow. With reference to three cases, it is shown th at simultaneous debridement and bone reaming can improve clearance of the infection. Using decortication and autologous cancellous bone graf ting, it is possible to leave the center of the bone free by temporari ly inserting a silicon tube. As a result cancellous bone can be saved and the danger of a relapse will be minor. In two cases this technique with the central silicon tube was applied for the first time within t he scope of plastic surgery with cancellous bone. If, as in the third case, there is enough bone substance in the region of the pseudarthros is with swelling of the soft tissue or fistulation, in selected cases reaming of the bone cavity and decortication are all that is necessary . The average length of follow up was 19 months. Only in one of our ca ses did local inflammation recur 9 months after clearance, which heale d rapidly with conservative procedures. The other patients had no epis odes of this nature, In our group, the patients achieved full weight-b earing on their leg without external support in an average of 5 months . Compared with another study conducted in Liestal, in which a similar group (infected pseudarthrosis with bone defects of 4-11 cm) was trea ted by the Ilizarov technique, shortening of the treatment by an avera ge of 4 months was obtained. This proves that it makes sense to leave vital cortical bone elements in the case of partial segmental bone los s if the surgeon is able to integrate the bone graft into the reconstr uction by an adequate operative techniqe.