Mylène Jansen

158 Chapter 8 Treatment The treatment protocol in regular care has been extensively described. 9 In short, the tibia and femur were distracted for at least 5 mm for 6 to 7 weeks, using an external fixation frame (KneeReviver®) that consisted of 2 distraction tubes, 1 placed medially and 1 laterally of the knee joint. The tubes were fixed to the bones using 8 trans-cutaneous half pins, placed in pairs at 4 locations (medial/lateral and tibia/femur), as shown in Figure 1. Distraction was obtained gradually over the course of 3 days, and after radiographic confirmation, patients were discharged from the hospital with a standard prescription for 7 days of oral antibiotics (flucloxacillin; 3 times per day 500 mg) only to be used in case of infection (not as prophylaxis). In case a patient suspected a pin tract infection, they consulted their physician and based on the physician’s judgment started their 7-day antibiotic course. If this standard course was not enough or more infections occurred during the distraction period or shortly thereafter, patients received additional antibiotic courses as necessary. During treatment, full weight-bearing was encouraged, supported by crutches if necessary. After 4 weeks patients returned to the outpatient clinic for a general evaluation, and after 6 to 7 weeks the distraction frame was removed in daycare. Figure 1 : The external fixation frame used for knee joint distraction treatment.