A case of an osteolysis by Mitek anchor-suture is presented.

In the management of malignancies of the extremities, limb salvage procedures have recently taken on greater significance. For those patients under intense adjuvant chemotherapy and with massive bone loss, free vascularized fibular grafting is currently advocated as a reliable reconstructive option, maybe because of the controversial results of bone transport in similar situations. However, when there is a vascular abnormality of either the recipient or donor extremity, microsurgical procedures are not feasible, further limiting potential reconstructive alternatives. We present the case of a 13-year-old female patient with Ewing's sarcoma of the right tibia. Preoperative angiography showed that vascularity of the affected side depended totally on a single peroneal artery. The patient was treated initially with multiagent chemotherapy, followed by an excision of 23 cm. The defect was bridged by a gradual medial transportation of the ipsilateral fibula with the Ilizarov technique and strengthened by nonvascularized transfer of the contralateral fibula. Total external fixation time was 162 days. After the removal of the Ilizarov frame a walking cast was applied for another month. At 5 years postoperatively there was no recurrence of the malignancy. The patient had full weight-bearing ability on the affected limb, with preservation of the ankle and knee joints motion and without any limb length discrepancy or axial deformity. The functional outcome that was visible was graded excellent. Transverse distraction osteogenesis of the ipsilateral fibula performed well under chemotherapy, showing unproblematic callus formation. Supplemented with nonvascularized transfer of the contralateral fibula, provided a reconstructive option with biological affinity, sufficient biomechanical strength and durability, and with a decreased complication rate. This case report presents a viable option, especially in cases in which vascular abnormalities of either the donor or the recipient limb, combined with multiagent chemotherapy, restrict potential reconstructive alternatives. It also highlights why vascularized bone graft should not be regarded as a panacea for all situations in which a fibular graft is required. Level IV, case report.

Background: Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication due to the poor healing potential of infected cancellous bone; this is in addition to the increased likelihood of contamination of adjacent joints. The purpose of this study was to determine the extent and level of evidence in relation to (1) available treatment options for the management of septic tibial metaphyseal nonunions; (2) success rates and bone healing following treatment application; and (3) functional results after intervention. Methods: We searched the MEDLINE, Embase, and CENTRAL databases for prospective and retrospective studies through to 25 January 2021. Human-only studies exploring the efficacy of various treatment options and their results in the setting of septic, quiescent, and metaphyseal (distal or proximal) tibia nonunions in the adult population were included. For infection diagnosis, we accepted definitions provided by the authors of source studies. Of note, clinical heterogeneity rendered data pooling inappropriate. Results: In terms of the species implicated in septic tibial nonunions, staphylococcus aureus was found to be the most commonly isolated microorganism. Many authors implemented the Ilizarov external fixation device with a mean duration of treatment greater than one year. Exceptional or good bone and functional results were recorded in over 80% of patients, although the literature is scarce and possible losses of the follow-up were not recorded. Conclusion: A demanding orthopedic condition that is scarcely studied is infected metaphyseal tibial nonunion. External fixation seems promising, but further research is needed. Systematic Review Registration: PROSPERO No. CRD42020205781.

Septic tibial nonunion regarding proximal metaphysis is a rare complication with devastating results. Due to scarce literature about this condition, a prospective interventional study using Ilizarov External Frame was conducting with participants recruitment from December 2020 till January 2022. Primary outcomes were bone healing and infection eradication while side-effects were reported. Secondary outcomes were the final leg length discrepancy (LLD) more than 2.5 cm, external fixation time, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, the Knee Outcome Survey-Activity of Daily Living Scale (KOS-ADSL) score, the American Academy of Orthopedic Surgeons (AAOS) Lower Limb Scale, the quality-adjusted life year (QALY) Time Trade-Off and the Short-Form 12 (SF-12) physical and mental score. 17 patients (16 males) with infected proximal tibial nonunions were treated with an Ilizarov external fixator at the Orthopedic Department of Serres General Hospital in Serres, Greece. Fracture healing and infection eradication were achieved in all patients with minimum follow-up of 30 months. Tibia deformity was present in four cases (23.5%), and length discrepancies were observed in one patient (3 cm). Limping was recorded in three patients. Stiffness of the knee or ankle was reported in six patients but all patients except one were pain-free. Everyone resumed their work or daily activities. According to ASAMI, the bone results were excellent in 13 patients, good in three patients, and fair in one. Analogously, the functional results were excellent in 11 patients, good in two and fair in 4 patients. Patient Reported Outcome Measures (PROMs) display an impressive improvement over the observation period. The Ilizarov method is a reliable technique for managing septic proximal tibial metaphyseal nonunions, particularly in cases involving extensive bone loss and existing deformities. Of vital importance is the assembling of an experienced multidisciplinary team to manage these rare and complex clinical conditions. ISRCTN30905788 (SePseT Ilizarov).