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Kummer A, Nieuwoudt L, Marais LC. Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications. Strategies Trauma Limb Reconstr 2024; 19:73-81. [PMID: 39359357 PMCID: PMC11443615 DOI: 10.5005/jp-journals-10080-1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/19/2024] [Indexed: 10/04/2024] Open
Abstract
Aim Reconstruction of segmental bone defects with bone transport is a well-established treatment. Mechanical complications at the docking site after frame removal are common. These complications include malunion, non-union, axial deviation and refracture. A simple tool to assess the healing of the docking site is currently lacking. The aim of this study is to evaluate the use of the modified RUST (mRUST) score in the setting of bone transport and to identify factors associated with an increased risk of docking site complications. Methods This retrospective study was conducted at a single tertiary centre in South Africa, included 24 patients with a tibial bone defect treated with bone transport and a circular frame between 2014 and 2023. Demographic data, clinical and bone transport characteristics were recorded. Mechanical complications, such as fracture, non-union, any angulation >5°, shortening >5 mm, or any other complication requiring reoperation, were recorded. The mRUST was adapted as a ratio for the purpose of this study to overcome the common occurrence of cortices being obscured by the frame. The mRUST ratio was applied before and after frame removal for each patient by three appraisers. Comparison between the groups with and without complications was performed regarding bone transport characteristics, docking site configuration and mRUST ratio. The correlation of the score between radiographs before and after frame removal was assessed. The inter-rater reliability of the mRUST was analysed using Fleiss Kappa statistics for each cortex individually and the intraclass correlation coefficient (ICC) for the mRUST ratio. Results In this study, 20 men and 4 women with a median age of 26 years were included. The overall rate of mechanical complications after frame removal was 21.7%. Complications were all related to the docking site, with two angulations, two fractures and one non-union. Demographics, bone transport characteristics and mRUST ratio before and after frame removal were similar between the two groups. Regarding the configuration of the docking site, an angle of 45° or more between the bone surfaces was associated with the occurrence of mechanical complications (p < 0.001). The correlation of the mean mRUST ratio before and after frame removal showed a moderate relationship, with a Spearman correlation coefficient of 0.50 (p-value 0.13). The inter-rater reliability of the mRUST was "fair" (kappa 0.21-0.40) for the scoring of individual cortices, except for one score which was "slight" (kappa 0.00-0.20). The ICC of the mRUST ratio was 0.662 on radiographs with the frame, and 0.759 after frame removal. Conclusion This study did not find the mRUST or mRUST ratio useful in assessing the healing of the docking site to decide on the best time to remove the frame. However, a notable finding was that the shape and orientation of the bone ends meeting at the docking site might well be relevant to decrease complication rates. If the angle between the bony surfaces is 45° or more, it may be associated with an increased risk of complications. It may be worthwhile considering reshaping these bone ends at the time of debridement or formal docking procedure to be more collinear, in order to reduce the potential for mechanical complications such as non-union, axial deviation or refracture at the docking site. How to cite this article Kummer A, Nieuwoudt L, Marais LC. Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications. Strategies Trauma Limb Reconstr 2024;19(2):73-81.
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Affiliation(s)
- Anne Kummer
- Department of Orthopaedic Surgery, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Luan Nieuwoudt
- Department of Orthopaedic Surgery, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Leonard Charles Marais
- Department of Orthopaedic Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Feng D, Zhang Y, Wu W, Jia H, Ma C. Docking site complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects. J Orthop Surg Res 2023; 18:889. [PMID: 37993906 PMCID: PMC10666420 DOI: 10.1186/s13018-023-04356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Treating long bone defects of the extremities caused by trauma, infection, tumours, and nonunion has been challenging for clinical orthopaedic surgeons. Bone transport techniques have the potential to treat bone defects. However, inevitable docking site complications related to bone transport techniques have been reported in many studies. The purpose of this study was to investigate the risk factors associated with docking site complications in patients who underwent the Ilizarov bone transport technique for the treatment of tibial bone defects. METHODS This retrospective study included 103 patients who underwent bone transport for the treatment of large bone defects in the tibia from October 2012 to October 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, univariate analysis and logistic regression analysis were used to analyse the factors that may affect the development of docking site complications in patients with tibial bone defects treated with the Ilizarov bone transport technique. The clinical outcomes were evaluated using the Association for the Study and Application of the Ilizarov criteria (ASAMI) at the last clinical follow-up. RESULTS All 103 patients with an average follow-up of 27.5 months. The docking site complications rate per patient was 0.53, and delayed union occurred in 22 cases (21.4%), axial deviation occurred in 19 cases (18.4%) and soft tissue incarceration occurred in 10 cases (9.7%). According to the results of the logistic regression analysis, the bone defect length (P = 0.001, OR = 1.976), and bone defect of distal 1/3 (P = 0.01, OR = 1.976) were significantly correlated with delayed union. Bone defect length (P < 0.001, OR = 1.981) and external fixation time (P = 0.012, OR = 1.017) were significantly correlated with axial deviation. Soft tissue defects (P = 0.047, OR = 6.766) and the number of previous operations (P = 0.001, OR = 2.920) were significantly correlated with soft tissue incarceration. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.1% and a rate of excellent functional results of 90.3%. CONCLUSION The Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect length, external fixation time, the number of previous operations, soft tissue defects and the bone defect of distal 1/3 are statistically significantly associated with the occurrence of docking site complications.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Yaxin Zhang
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Weize Wu
- Department of Joint Surgery, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
| | - Chuang Ma
- Department of Orthopaedic, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Feng D, Zhang Y, Jia H, Xu G, Wu W, Yang F, Ding J, Li D, Wang K, Luo Y, Liu X, Guo Q, Zong Z. Complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects-a retrospective study of 199 cases. BMC Musculoskelet Disord 2023; 24:864. [PMID: 37936087 PMCID: PMC10629116 DOI: 10.1186/s12891-023-06955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinical treatment of long bone defets in the extremities caused by trauma, infection, tumours, and nonunion has been a challenge for orthopaedic surgeons. Bone transport techniques have become the only way to treat such bone defects. However, inevitable difficulties and complications related to bone transport techniques have been reported in many studies. AIM The purpose of this study was to investigate the risk factors for complications and the effectiveness of the Ilizarov bone transport technique in the treatment of tibial bone defects. METHODS The study was conducted in 199 patients who underwent treatment with the Ilizarov bone transport technique at our institution from May 2012 to September 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, a risk factor analysis was performed for the top three major complications. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical follow-up. RESULTS A total of 199 patients underwent follow-up for 12-40 months, with an average of 23.5 months, and all achieved bone healing. A total of 310 complications occurred, with an average of 1.04 minor complications and 0.48 major complications per patient. The top three complications were pin tract infection in 48 cases (61.3%), axial deviation in 86 cases (43.2%), and delayed union in 50 cases (25.13%). Multivariate analysis showed that the bone defect length (P = 0.02, OR = 5.489), the number of previous surgeries (P = 0.003, OR = 2.204), and the external fixation index (P = 0.01, OR = 1.202) were significantly correlated with pin tract infection. Bone defects of the middle 1/3 (P < 0.001, OR = 23.769), the bone defect length (P < 0.001, OR = 2.776), and the external fixation index (P < 0.001, OR = 1.154) were significantly correlated with axial deviation. The bone defect length (P = 0.003, OR = 1.242), soft tissue defects (P = 0.013, OR = 0.312) and bone defects of the distal 1/3 (P = 0.023, OR = 4.257) were significantly correlated with delayed healing. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.48% and a rate of excellent functional results of 87.94%. CONCLUSION The Ilizarov bone transfer technique is an effective method for treating tibial bone defects, and shortening the treatment period can reduce the incidence of complications. Older patients and those with longer bone defects, a higher external fixation index, more previous operations, and defects of the middle and distal 1/3 had a higher incidence of complications.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Yaxin Zhang
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Guogang Xu
- Department of Otolaryngology and Head Surgery, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Weize Wu
- Department of Pathology, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Fan Yang
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Jianan Ding
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Dong Li
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Kang Wang
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Yongjie Luo
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Xin Liu
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Qi Guo
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Zhiguo Zong
- Department of Joint Surgery, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
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Glatt V, Tetsworth K. Biomimetic Hematoma as a Novel Delivery Vehicle for rhBMP-2 to Potentiate the Healing of Nonunions and Bone Defects. J Orthop Trauma 2023; 37:S33-S39. [PMID: 37828700 DOI: 10.1097/bot.0000000000002692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
SUMMARY The management of bone defects and nonunions creates unique clinical challenges. Current treatment alternatives are often insufficient and frequently require multiple surgeries. One promising option is bone morphogenetic protein-2 (BMP-2), which is the most potent inducer of osteogenesis. However, its use is associated with many side effects, related to the delivery and high doses necessary. To address this need, we developed an ex vivo biomimetic hematoma (BH), replicating naturally healing fracture hematoma, using whole blood and the natural coagulants calcium and thrombin. It is an autologous carrier able to deliver reduced doses of rhBMP-2 to enhance bone healing for complex fractures. More than 50 challenging cases involving recalcitrant nonunions and bone defects have already been treated using the BH delivering reduced doses of rhBMP-2, to evaluate both the safety and efficacy. Preliminary data suggest the BH is currently the only clinically used carrier able to effectively deliver reduced doses (∼70% less) of rhBMP-2 with high efficiency, rapidly and robustly initiating the bone repair cascade to successfully reconstruct complex bone injuries without side effects. The presented case provides a clear demonstration of this technology's ability to significantly alter the clinical outcome in extremely challenging scenarios where other treatment options have failed or are considered unsuitable. A favorable safety profile would portend considerable promise for BH as an alternative to bone grafts and substitutes. Although further studies regarding its clinical efficacy are still warranted, this novel approach nevertheless has tremendous potential as a favorable treatment option for bone defects, open fractures, and recalcitrant nonunions.
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Affiliation(s)
- Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX
- Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Kevin Tetsworth
- Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; and
- Herston Biofabrication Institute, Orthopaedic Clinical Stream, Herston, Queensland, Australia
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Shimokawa K, Matsubara H, Hikichi T, Tsuchiya H. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023; 18:117-122. [PMID: 37942427 PMCID: PMC10628609 DOI: 10.5005/jp-journals-10080-1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/20/2023] [Indexed: 11/10/2023] Open
Abstract
Aim Bone transport is a beneficial reconstructive method for bone defects caused by infected non-unions or bone tumours. The Taylor Spatial Frame (TSF) is a three-dimensional corrective external fixator that can be used to achieve bone transport and correct any residual deformities easily at any time. This study reports the results of bone transport using TSF. Materials and methods This is a retrospective study of ten patients who underwent bone transport using the TSF. The mean age was 32.3 years; the femur was affected in one case and the lower leg in nine. Bone defects were due to infected non-unions in seven cases and bone tumours in three. The duration of external fixation, bone transport distance, distraction index (DI), alignment at the end of correction, leg length discrepancy, and complications were investigated. Results The average bone transport distance was 76.0 mm. The external fixation period averaged 367 days with the DI at 20.8 days/cm. Deformity at the docking site was assessed to have an average 2.6° deformity and 2.0 mm translation in the frontal view, as well as 3.3° deformity and 3.7 mm translation in the lateral view. The mean leg length discrepancy was 10.9 mm and the percentage of the mechanical axis (%MA) was 40.6%. Four patients underwent plate conversion after correction and two required additional surgery for non-union at the docking site. Bone union was achieved in all patients and there was no reaggravation of infection or tumour recurrence. Conclusion The TSF allowed for the correction of deformities and translations that occurred during bone transport giving excellent results. However, as with bone transport using this or other devices, additional procedures are often needed to obtain consolidation or docking site union. How to cite this article Shimokawa K, Matsubara H, Hikichi T, et al. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):117-122.
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Affiliation(s)
- Kanu Shimokawa
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Toshifumi Hikichi
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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Xu Y, Ma T, Ren C, Li M, Lu Y, Sun L, Huang Q, Wang Q, Xue H, Li Z, Zhang K. Treatment of tibial large bone defects: A comparative study of bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate. Injury 2022; 54 Suppl 2:S78-S85. [PMID: 36192202 DOI: 10.1016/j.injury.2022.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate versus bone transport alone with antibiotic-impregnated calcium sulphate for the treatment of tibial large bone defects. METHODS A retrospective analysis was conducted by enroling 33 surgically treated patients with tibial large bone defects after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic orthopaedic Department, Xi'an Honghui Hospital from January 2018 to January 2021. All the patients were categorized in Group A (transport over intramedullary nail, 12 cases) and Group B (transport alone, 21 cases) based on the surgery strategy. The collected clinical materials and data included gender, age, injury mechanism, smoking habits, comorbidity diseases, initial fracture type (open or close), bone defect size, surgical duration, intraoperative bleeding loss, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, weight bearing time, complications and Paley bone and functional criteria. RESULTS Thirty-three patients were enroled and successfully followed up with an average time of 15.25±4.31 months ranged from 8 to 21 months in Group A and an average time of 17.09±5.64 months ranged from 9 to 31 months in Group B. No significantly statistical differences of the demographic data were discovered between the two groups. There were no significantly statistical differences of the average bone defect size, intraoperative bleeding loss, resorption time of calcium sulphate and bone transport time between the two groups. However, the average surgical duration (P = 0.002) was significantly longer in Group A than Group B and the average external fixation time (P<0.001), external fixation index(P = 0.002) and weight bearing time (P = 0.030) were significantly shorter in Group A than Group B. No significantly statistical difference of excellent and good rate of bone outcomes and complication rate was observed, however, the excellent and good rate of functional outcomes (P = 0.041) was significantly higher in Group A than Group B. CONCLUSION Compared with the conventional Ilizarov technique combining with antibiotic-impregnated calcium sulphate for large tibial bone defects, bone transport over an intramedullary nail in combination with antibiotic-impregnated calcium sulphate had favourable external fixation time, external fixation index, weight bearing time and clinical functional outcomes which effectively suppressed the infection and allowed patients earlier removal of the external fixator and weight bearing for rehabilitation.
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Affiliation(s)
- Yibo Xu
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Teng Ma
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Cheng Ren
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Ming Li
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Yao Lu
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Liang Sun
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Qiang Huang
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Qian Wang
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Hanzhong Xue
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
| | - Zhong Li
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China.
| | - Kun Zhang
- Department of Orthopaedics Trauma, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China.
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Merchan N, Narvel RI, Gitajn IL, Henderson ER. Use of the PRECICE Nail for distraction osteogenesis after tumor resection. Expert Rev Med Devices 2022; 19:469-475. [PMID: 35912406 DOI: 10.1080/17434440.2022.2108704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Reconstructing long bone defects following intercalary tumor resection presents an exciting challenge with a greater range of surgical solutions than more typical situations requiring arthroplasty. Segmental bone transport (distraction osteogenesis) is the least utilized option for intercalary reconstruction, however, it arguably provides patients with the most desirable result. Distraction osteogenesis can be used in the management of multiple skeletal conditions including deformity (either congenital or acquired), or in the presence of bone defects (by trauma or planned surgical excision). Lack of broader adoption of transport is likely due to the highly technical demands and common complications of utilizing fine-wire fixators via the Ilizarov method. More recently, internal lengthening nails such as the PRECICE nail have been employed to facilitate distraction osteogenesis without the added complexity of external fixation. AREAS COVERED This review will examine the literature on the indications, design, and safety of the PRECICE nail (NuVasive) for intercalary reconstruction after tumor resection. EXPERT OPINION Bone transport using the PRECICE nail represents a viable alternative to Ilizarov distraction and has the benefit of avoiding the complications of an external fixator. For large defects, the PRECICE nail can be supplemented with a locking plate for additional stability and maintenance of limb length.
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Affiliation(s)
- Nelson Merchan
- Department of Orthopaedic Surgery. Dartmouth-Hitchcock Medical Center
| | - Raed I Narvel
- Department of Orthopaedic Surgery. Dartmouth-Hitchcock Medical Center
| | - I Leah Gitajn
- Department of Orthopaedic Surgery. Dartmouth-Hitchcock Medical Center
| | - Eric R Henderson
- Department of Orthopaedic Surgery. Dartmouth-Hitchcock Medical Center
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Li J, Li M, Wang W, Li B, Liu L. Evolution and Development of Ilizarov Technique in the Treatment of Infected Long Bone Nonunion with or without Bone Defects. Orthop Surg 2022; 14:824-830. [PMID: 35343060 PMCID: PMC9087454 DOI: 10.1111/os.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023] Open
Abstract
The treatment of infected bone nonunion and bone defects is a considerable challenge in the orthopedics field. The standard clinical therapy methods include local free bone transplantation, vascularized bone graft, and the Ilizarov technique; the first two are controversial due to the iatrogenic self‐injury. The Ilizarov bone transport technique has been widely used to treat infected bone nonunion and bone defects, and good clinical effect has been demonstrated. Yet, it brings many related complications, which exerts additional suffering to the patient. The best treatment is to combine bone defect rehabilitation with infection control, intramedullary nail fixation, appropriate time for bone grafts, beaded type scaffold slippage and new Taylor fixation, reducing the external fixation time and the incidence of complications, thereby reducing the occurrence of patients' physical and psychological problems. This review focuses on the induction, summary and analysis of the Ilizarov bone transport technique in the treatment of infected long bone nonunion with or without bone defects, providing new ideas and methods for orthopedic disease prevention and treatment by the Ilizarov technique, which is following the development direction of digital orthopedics.
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Affiliation(s)
- Jun Li
- Department of Orthopedics, Orthopedic Research Institute, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingxin Li
- Department of Orthopedics, Orthopedic Research Institute, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenzhao Wang
- Department of Orthopedics, Orthopedic Research Institute, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bohua Li
- Department of Orthopedics, Orthopedic Research Institute, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Orthopedics, Orthopedic Research Institute, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Liu K, Abulaiti A, Liu Y, Cai F, Ren P, Yusufu A. Risk factors of pin tract infection during bone transport using unilateral external fixator in the treatment of bone defects. BMC Surg 2021; 21:377. [PMID: 34702235 PMCID: PMC8547064 DOI: 10.1186/s12893-021-01384-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background The bone transport using the unilateral external fixator, one of the Ilizarov techniques, is widely practiced in lower limb reconstructive surgery. Pin tract infection (PTI), one of most common complication, has become the important postoperative problems which plague clinicians gradually. Methods A group of 130 patients who received bone transport surgery for tibia or femur defects using the unilateral external fixation (Orthofix limb reconstruction system, Verona, Italy) and met the inclusion criteria were selected for the study from 2015 to 2019. Regular pin tract care was performed twice a day, and the conditions of the pin tract were evaluated by the same observer using clinical appearance criteria. The Saw’s classification of PTI was used to assess the condition around screws. After the data were significant by the T-test or Pearson’s Chi-square test analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of PTI. Results Ninety-one males and thirty-nine females with a mean age of 43 years (range 28–58 years) were included in this cohort. 7816 observations were documented from 12 to 36 months, and 58 cases (44.6%) of PTI (thirty-nine cases in grade 1, 17 cases in grade 2, and 2 cases in grade 3). The top five risk factors were agricultural work (OR 1.86, CI 0.94–2.39), non-urban living (OR 1.75, CI 1.24–3.26), male (OR 1.71, CI 1.02–2.31), smoking (OR 1.53, CI 0.76–1.89), and diabetes (OR 1.26, CI 1.12–2.64). No long-term sequelae were observed at the latest clinical visit. Conclusion Occupation, gender, living environment (non-urban), smoking, and diabetes were the top five significant risk factors for PTI in the period of bone transport using unilateral external fixation. Awareness of predictable risk factors of PTI is beneficial to avoid or early detect the severe complications which can affect the effectiveness.
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Affiliation(s)
- Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Alimujiang Abulaiti
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Xie J, Zhao G, Yasheng T, Chen H, Amuti N, Maimaitirexiati M, Yibulayinmu A, Cao M, Yusufu A. Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study. J Int Med Res 2021; 49:3000605211002701. [PMID: 33761779 PMCID: PMC8166389 DOI: 10.1177/03000605211002701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones. Methods Patients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley’s criteria for bone healing and functional assessment. Results In total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11–61 years). The patients were followed up for at least 24 months. According to Paley’s criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%). Conclusion Infected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.
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Affiliation(s)
- Jiang Xie
- Department of Orthopedic Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Guobin Zhao
- Department of Orthopedics, Urumqi Friendship Hospital, Urumqi, Xinjiang, China
| | - Tayierjiang Yasheng
- Department of Orthopedic Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hongtao Chen
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Nuermaimaiti Amuti
- Department of Orthopedics, The First People's Hospital of Kashgar Area, Kashgar, Xinjiang, China
| | - Muhetaer Maimaitirexiati
- Department of Orthopedics, The First People's Hospital of Kashgar Area, Kashgar, Xinjiang, China
| | | | - Mingyu Cao
- Department of Orthopedic Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1375-1386. [PMID: 33555442 DOI: 10.1007/s00590-020-02862-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although bone transport is generally accepted as the gold standard for the treatment of segmental septic bone defects, some aspects of its practical application are still open to debate. We present our results in this field and compare them with the series published so far. MATERIAL AND METHODS We reviewed all our patients (2010-2018) that underwent a bone transport procedure in the lower limb due to a septic bone defect. We calculated the bone healing index (BHI), the external fixation index (EFI), the rate of complications and the clinical results. We statistically compared our results with 63 publications with a similar scope. RESULTS Thirty-five patients (30 M/5F) with a mean age of 40 years and a mean follow-up of 45 months were included. Bone segment was 24 T/11F and mean defect was 8.4 cm (7.34 T/ 10.73F). Mean global BHI was 45.62 days/cm (48.16 T/40.09F). Mean EFI was 2.37 months/cm. Results were excellent in 9 patients, good in 23 and bad in 3. Bone graft was used in 60% of the cases. DISCUSSION The size of our series is similar to previously published ones, although the mean age of our patients is higher and they present a larger bone defect. BHI of our series is similar to that of other series, although EFI is significantly higher. The number of complications is also in line with the existing literature. CONCLUSION The use of a two-stage technique for managing segmental bone defects of septic origin in the lower extremity is a valid alternative. Our series shows results comparable to the current literature.
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Classification of Bone Defects: An Extension of the Orthopaedic Trauma Association Open Fracture Classification. J Orthop Trauma 2021; 35:71-76. [PMID: 32639397 DOI: 10.1097/bot.0000000000001896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a post-traumatic bone defect classification scheme and complete a preliminary assessment of its reliability. DESIGN Retrospective classification. SETTING Tertiary referral trauma center. PATIENTS/PARTICIPANTS Twenty open fractures with bone loss. INTERVENTION Assignment of a bone defect classification grade. MAIN OUTCOME MEASUREMENTS Open fractures were classified based on orthogonal radiographs, assessing the extent and local geometry of bone loss, including D1-incomplete defects, D2-minor/subcritical (complete) defects (<2 cm), and D3-segmental/critical-sized defects (≥2 cm). Incomplete defects (D1) include D1A-<25% cortical loss, D1B-25%-75% cortical loss, and D1C->75% cortical loss. Minor/subcritical (complete) defects (<2 cm) (D2) include D2A-2 oblique ends allowing for possible overlap, D2B-one end oblique/one end transverse, and D2C-2 transverse ends. Segmental/critical-sized Defects (≥2 cm) include D3A-moderate defects, 2 to <4 cm; D3B-major defects, 4 to <8 cm; and D3C-massive defects, ≥8 cm. Reliability was assessed among 3 independent observers using Fleiss' kappa tests. RESULTS Interobserver reliability demonstrated the classification scheme has very good agreement, κ = 0.8371, P < 0.0005. Intraobserver reliability was excellent, κ = 1.000 (standard error 0.1478-0.1634), P < 0.00001. Interobserver reliability for the distinction between categories alone (D1, D2, or D3) was also excellent, κ = 1.000 (standard error 0.1421-0.1679), P < 0.00001. CONCLUSIONS This classification scheme provides a robust guide to bone defect assessment that can potentially facilitate selection of the most appropriate treatment strategy to optimize clinical outcomes.
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Summers S, Krkovic M. Bone transport with magnetic intramedullary nails in long bone defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1243-1252. [PMID: 33367945 PMCID: PMC7759217 DOI: 10.1007/s00590-020-02854-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
Background This study describes the outcomes of internal bone transport with magnetic nails in five cases of traumatic segmental femoral bone defects. Methods Five patients with open fracture of the femur and diaphyseal bone loss were included between May 2018 and August 2020. The mean femoral defect was 8.7 cm (range 5.6–16.0). Intervention We used plate-assisted bone segment transport (PABST) with PRECICE magnetic nails. Results All five patients have fully consolidated. The mean consolidation time and index were 7.5 months and 0.8 mo/cm, respectively. The mean follow-up was 21.3 months. The main complications were reduced knee ROM, mild varus deformity and plate bending. Post-operative SF-36, Oxford Knee scores and ED-5Q-5L scores were also compiled for four of five patients. SF-36 and Oxford Knee scores were reported without pre-injury data for comparison. ED-5Q-5L index and VAS were compared UK population norm and were both found to be statistically insignificant (p = 0.071 and p = 0.068, respectively). Conclusion Bone transport with magnetic nails has the capacity to obtain good functional recovery in long bone defects despite variable outcome pictures. In response to variable outcome reporting in the literature, we propose a standard reporting template for future studies to facilitate more rigorous analyses.
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Affiliation(s)
- Selina Summers
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, CB2 0SP UK
| | - Matija Krkovic
- Addenbrookes Major Trauma Unit, Department of Trauma and Orthopaedics, Cambridge University Hospitals, Cambridge, UK
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Wen H, Zhu S, Li C, Xu Y. Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis. BMC Musculoskelet Disord 2020; 21:80. [PMID: 32028924 PMCID: PMC7006089 DOI: 10.1186/s12891-020-3114-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the safety and efficacy between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects. Methods A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The modified Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Standard mean difference (SMD) was used for continuous variables and relative risk (RR) for the binary variables. All of the variables included its 95% confidence interval (CI). Results Five studies, including a total of 199 patients, were included in the study. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P < 0.00001); however, no significance was observed in bone union time (SMD = − 0.02, 95% CI: − 0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37). Conclusions AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.
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Affiliation(s)
- Hongjie Wen
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shouyan Zhu
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Canzhang Li
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yongqing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, NO. 212 Daguan Road, Xi Shan District, Kunming City, 650021, Yunnan Province, China.
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Relevant advances in bone lengthening research: a bibliometric analysis of the 100 most-cited articles published from 2001 to 2017. J Pediatr Orthop B 2019; 28:495-504. [PMID: 30312248 DOI: 10.1097/bpb.0000000000000557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aimed to assess the scientific production of bone lengthening research by identifying the most-cited papers. All articles including the term 'bone lengthening' published between 2001 and 2017 were retrieved through the Web of Science database. The 100 most-cited articles on bone lengthening included a total of 4244 citations, with 414 (9.7%) citations in 2017. There was an average of 249.6 citations per year. The articles predominantly addressed biomechanics and bone formation (38). Different surgical techniques, including intramedullary nail (14), Ilizarov (nine), intramedullary skeletal kinetic distractor (ISKD) (six), Taylor spatial frame (6), the PRECICE device (three), and lengthening and submuscular locking plate (three), were the second most-studied topic. Most studies were therapeutic (58), whereas 30 studies were experimental investigations using animal models. Among the clinical studies, case series were predominant (level of evidence IV) (57). This study presents the first bibliometric analysis of the most relevant articles on bone lengthening. The list is relatively comprehensive in terms of identifying the top issues in this field. However, the most influential clinical studies have a poor level of evidence, although a slight tendency toward a better level of evidence has been observed in more recent years.
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Prevalence and patterns of traumatic bone loss following open long bone fractures at Mulago Hospital. OTA Int 2019; 2:e015. [PMID: 33937651 PMCID: PMC7953543 DOI: 10.1097/oi9.0000000000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
Introduction: Significant traumatic bone loss in developed countries occurs in a high proportion of open fractures ranging from 11.4% to 40%. However, literature from developing countries such as Uganda scarcely documents the prevalence and patterns of traumatic bone loss. Direct trauma and iatrogenic factors have been associated with traumatic bone loss as possible etiologies. Objective: The study was aimed at establishing the prevalence and patterns of traumatic bone loss following open long bone fractures, and identifying factors associated with traumatic bone loss among patients presenting to Mulago Hospital within 24 hours of sustaining the injury up to completion of the initial fracture debridement, reduction, and fixation. Methodology: It was a prospective cohort study conducted at Mulago Hospital. A total of 136 open long bone fractures were registered and physically examined for traumatic bone loss. Patients who consented were recruited consecutively to participate in the study. Data on the patients’ sociodemographics and fracture patterns were collected using pretested questionnaires and analyzed using Stata version 12. Results: From 123 patients, a total of 136 open long bone fractures were registered. The prevalence of traumatic bone loss following open long bone fractures was 26.5%. Of the 36 open long bone fractures with traumatic bone loss, the more common pattern (61.1%) was significant traumatic bone loss (≥ 2.5 cm long). Commercial motorcycle riders (22.0%) and traders (20.3%) were the most common occupations associated with open long bone fractures. Gunshot injuries were the leading cause of traumatic bone loss in open long bone fractures. Conclusion: Our setting has a high prevalence of traumatic bone loss among open long bone fractures with the majority occurring in Gustilo type IIIB injuries of the tibia. The likelihood of traumatic bone loss is higher in open fractures caused by gunshots.
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Bakhsh K, Atiq-Ur-Rehman, Zimri FK, Mohammad E, Ahmed W, Saaiq M. Presentation and management outcome of tibial infected non-union with Ilizarov technique. Pak J Med Sci 2019; 35:136-140. [PMID: 30881411 PMCID: PMC6408636 DOI: 10.12669/pjms.35.1.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications. Methods: This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad and Civil hospital, Quetta over a period of 3-years. Results: There were 56 patients with 53(94.64%) males and 3(5.35%) females. The age range was 16-50 years with a mean of 32.58±9.98years. According to ASAMI criteria, bone results were excellent in 37(66%), good in 10(17.85%), fair in 6(10.71%) and poor in 3(5.35%). The functional results were excellent in 37(66%), good in 9(16%), fair in 7(12.5%) and poor in 3(5.35%). The bone union rate was 98.21%. Conclusion: Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes.
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Affiliation(s)
- Karim Bakhsh
- Dr. Karim Bakhsh FCPS, Department of Orthopedics, Civil Hospital, Bolan Medical College, Quetta, Pakistan
| | - Atiq-Ur-Rehman
- Dr. Atiq-Ur-Rehman FCPS, Department of Orthopedics, Civil Hospital, Bolan Medical College, Quetta, Pakistan
| | - Faridullah Khan Zimri
- Dr. Faridullah Khan Zimri FCPS, Department of Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Eid Mohammad
- Dr. Eid Mohammad FCPS, Department of Orthopedics, Civil Hospital, Bolan Medical College, Quetta, Pakistan
| | - Wazir Ahmed
- Dr. Wazir Ahmed MS, Department of Orthopedics, Civil Hospital, Bolan Medical College, Quetta, Pakistan
| | - Muhammad Saaiq
- Dr. Muhammad Saaiq FCPS, Department of Orthopedics, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
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van Niekerk AH, Birkholtz FF, de Lange P, Tetsworth K, Hohmann E. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong) 2018. [PMID: 28639529 DOI: 10.1177/2309499017716242] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the outcome of combined circular external fixation and cemented polymethylmethacrylate (PMMA) spacer application between a cohort of patients with grade 3 open fractures and infected tibial nonunions and concomitant segmental bone loss. METHODS The study was designed as a retrospective cohort study. All patients who were treated for complex tibial fractures or infected nonunions with segmental bone loss between 2009 and 2013 were included if they were aged between 16 years and 60 years, sustained acute traumatic grade 3 open tibial fractures, presented with infected nonunion, and were followed up for a minimum of 12 months. Patients with a history of ipsilateral tibial fractures, contralateral lower extremity fractures, polytrauma, chest, or abdominal trauma and patients with head injuries were excluded. Both groups were treated with aggressive debridement, circular external fixation, and antibiotic-impregnated PMMA spacer. Outcome measures were the time in the external fixator (EFT) and the external fixation index (EFI). RESULTS Twenty-four patients with a mean age of 32 ± 14.7 years were included. Twelve patients with a mean age of 32 + 14 years and a mean bone defect of 82 + 36 mm were treated for acute complex grade 3 open tibial fractures, and 12 patients with a mean age of 35.1 + 15.7 years and a mean bone defect of 50 + 26 mm were treated for infected nonunions. There was no significant difference ( p = 0.44) between the groups for EFT (249 ± 99 days-tibial fractures; 255 ± 142 days-infected nonunion). There were significant between group differences ( p = 0.027) for EFI (37.3 ± 9.1 cm/days-tibial fractures; 56 ± 14.5 cm/days-infected nonunion). CONCLUSION The findings of this study suggest that patients were treated for infected nonunion with segmental bone loss using circular external fixation, distraction osteogenesis, and antibiotic-impregnated PMMA spacers, and the spacers may not offer any advantage over a conventional approach using the principles of osteogenesis only. In contrast, antibiotic-impregnated spacers for open tibial trauma were advantageous and reduced the EFI considerably.
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Affiliation(s)
- Andries H van Niekerk
- 1 Department of Orthopaedic Surgery, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Franz F Birkholtz
- 1 Department of Orthopaedic Surgery, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.,2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa
| | - Phillip de Lange
- 2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa
| | - Kevin Tetsworth
- 3 Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia.,4 Queensland University of Technology, Brisbane, Australia.,5 University of Queensland School of Medicine, Brisbane, Australia.,6 Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Erik Hohmann
- 2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa.,6 Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia.,7 Medical School, University of Queensland, Queensland, Australia.,8 School of Medicine, University of Pretoria, Pretoria, South Africa
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Wang H, Wei X, Liu P, Fu YH, Wang PF, Cong YX, Zhang BF, Li Z, Lei JL, Zhang K, Zhuang Y. Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia. Medicine (Baltimore) 2017; 96:e8569. [PMID: 29137077 PMCID: PMC5690770 DOI: 10.1097/md.0000000000008569] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20-55 years). All patients previously undergone an average of 2.9 operations (range: 1-6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3-12 cm), and all patients were suffering from soft tissue defects (range: 5-17 cm). The mean external fixator time (EFT) was 48 weeks (range: 30-62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33-62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0-3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.
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Tetsworth K, Paley D, Sen C, Jaffe M, Maar DC, Glatt V, Hohmann E, Herzenberg JE. Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects. Injury 2017; 48:2276-2284. [PMID: 28734494 DOI: 10.1016/j.injury.2017.07.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length. METHODS In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates. RESULTS The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28). CONCLUSIONS While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures. LEVEL OF EVIDENCE Level III; Retrospective comparative study.
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Affiliation(s)
- Kevin Tetsworth
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia
| | - Dror Paley
- Paley Institute, St. Mary's Hospital, West Palm Beach, FL, USA
| | - Cengiz Sen
- Department of Orthopaedic Surgery, Medical School of Istanbul, University of Istanbul, Istanbul, Turkey
| | - Matthew Jaffe
- Wellstar Health System, OrthoAtlanta private practice group, Atlanta, GA, USA
| | - Dean C Maar
- Department of Orthopaedic Trauma, St. Vincent's Hospital, Indianapolis, IN, USA
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; University of Texas Health Science Center, San Antonio, Texas, USA
| | - Erik Hohmann
- University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia; Musculoskeletal Research Unit, Central Queensland University, Rockhampton, QLD, Australia.
| | - John E Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
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Corona PS, Ramirez-Nuñez LJ, Amat C, Carrera L. Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame. Injury 2017; 48:2285-2291. [PMID: 28764916 DOI: 10.1016/j.injury.2017.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique. METHODS The aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques. RESULTS A total of 54 patients, with an average bone defect of 8.58cm (CI95% 7.01-10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases. CONCLUSION According our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than choice of osteotomy technique must play important roles.
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Affiliation(s)
- Pablo S Corona
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carles Amat
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Carrera
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Zhang Q, Zhang W, Zhang Z, Tang P, Zhang L, Chen H. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union. Injury 2017; 48:2270-2275. [PMID: 28756873 DOI: 10.1016/j.injury.2017.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/20/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND A variety of approaches have been used to treat oligotrophic or atrophic non-union. Conventional methods are often associated with great operative trauma, increased blood loss, a risk of re-infection, higher medical costs, and complications at the donor site. This study aimed to assess the clinical efficacy of the accordion technique combined with Minimally Invasive Percutaneous Decortication (MIPD) for these types of bone non-union. METHODS From January 2010 to December 2015, 20 patients with long bone aseptic non-unions of the lower extremities without bone defects who were treated with the accordion technique combined with MIPD. The limb-length discrepancy (LLD) was less than 2cm in all patients. None of the patients received autogenous bone grafts during follow-up. All surgeries were performed by the same surgeon, and the modified Application of methods of Ilizarov (ASAMI) criteria were used to evaluate the operative effectiveness. RESULTS A total of 20 patients were included in this study, and 1 patient was lost during follow-up. Fifteen of these patients presented with oligotrophic non-unions, and 5 patients presented with atrophic non-unions. The average follow-up period in these patients was 12.1 months (range: 8-42 months). The alternative compression and distraction procedure was repeated 1-3 times. Blood loss was 30 to 250ml during surgery. Ultimately, bone union was achieved in 19 patients and failed in 1 patient. The fractures healed within 4-8 months (average time: 5.9 months), and fracture healing was considered excellent in 19 patients and poor in 1 patient. Postoperative function was evaluated as excellent in 9 patients, good in 6 patients, fair in 4 patients, and poor in 1 patient. CONCLUSION The accordion technique combined with MIPD, which is a simple, minimally invasive procedure that does not require autologous bone grafting, resulted in a high bone union rate and good postoperative function.
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Affiliation(s)
- Qun Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China.
| | - Wei Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China
| | - Zhuo Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China
| | - Peifu Tang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China
| | - Lihai Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China
| | - Hua Chen
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China
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Aktuglu K, Günay H, Alakbarov J. Monofocal bone transport technique for bone defects greater than 5 cm in tibia: our experience in a case series of 24 patients. Injury 2016; 47 Suppl 6:S40-S46. [PMID: 28040086 DOI: 10.1016/s0020-1383(16)30838-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND As the tibial bone defect increases in size, the problems in treatment also increase. The treatment may be problematic but different treatment approaches can be used. Among these approaches, distraction osteogenesis is a method an orthopedic surgeon with limited conditions can use although it has a longer treatment period. In our case series, we evaluated current treatment approaches. METHOD Retrospective study based on patient records and radiographs. We evaluated our cases with tibial bone defects Type B and greater than 5 cm. Twenty four cases were operated between 1995 and 2013. Clinical follow-up consisted of physical examination, review of radiographs, and Association for the Study of the Method of Ilizarov (ASAMI) scoring system of bone and functional results. RESULTS The defects had an average lenght of 7.01 cm (SD:2.88) (range, 5-18). The mean follow-up time from removal of the apparatus to the time of the last clinic visit averaged 74.08 ±24.17 months (range: 39-122). The Ilizarov frame was placed for transport and until bone was solid, average of 275.5 ± 70.6 days (range: 190-437 days). The mean external fixator time (EFT) was 350.91 ± 89.22 days (range: 261-627 days). The mean external fixator index (EFI) was 52 days/cm (range: 34.8-62.8 days/cm). Bone union was obtained in 23/24 (95.8%) patients. Seven patients suffered from stiffness (2 knee, 5 ankle) from which 3 patients developed equinus deformity and required tenoplasty (Achilles tendon lengthening at the time of frame removal. After reaching docking site, 5 patients needed intramedullary nailing to speed up union. Twelve (50%) cases had excellent radiological results, 8 (33%) cases had good, 2 (8%) cases fair and 2 (8%) cases had poor results. Regarding the functional ASAMI scoring system 14 (58%) cases had excellent, 9 (38%) cases had good and one case (4%) had fair result. CONCLUSION According to our experience, the Ilizarov bone transport technique remains a reliable method to repair bone defects. However, the treatment time is lengthy with a considerable risk of complications. We found closed intramedullary nailing as an effective and easy solution for cases without pin tract infections to manage the nonunion problem of the docking site and this option should be considered where the surgeon envisages difficulties of healing or the patient has lost patience with the frame. Careful selection of case and patient profile can optimize the outcomes.
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Affiliation(s)
- Kemal Aktuglu
- Ege University Medical Faculty Orthopaedic and Traumatology Departement, 35070 Bornova-Izmir, Turkey
| | - Hüseyin Günay
- Ege University Medical Faculty Orthopaedic and Traumatology Departement, 35070 Bornova-Izmir, Turkey.
| | - Jabrayil Alakbarov
- Azerbaijan Republic Ministry of Publik Healte Scientific Research Institute of Traumatologi and Orthopedics, 32 Abbas Sahhat Str, 1007 Baku, Azerbaijan
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Pigossi SC, Medeiros MC, Saska S, Cirelli JA, Scarel-Caminaga RM. Role of Osteogenic Growth Peptide (OGP) and OGP(10-14) in Bone Regeneration: A Review. Int J Mol Sci 2016; 17:ijms17111885. [PMID: 27879684 PMCID: PMC5133884 DOI: 10.3390/ijms17111885] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/24/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022] Open
Abstract
Bone regeneration is a process that involves several molecular mediators, such as growth factors, which directly affect the proliferation, migration and differentiation of bone-related cells. The osteogenic growth peptide (OGP) and its C-terminal pentapeptide OGP(10–14) have been shown to stimulate the proliferation, differentiation, alkaline phosphatase activity and matrix mineralization of osteoblastic lineage cells. However, the exact molecular mechanisms that promote osteoblastic proliferation and differentiation are not completely understood. This review presents the main chemical characteristics of OGP and/or OGP(10–14), and also discusses the potential molecular pathways induced by these growth factors to promote proliferation and differentiation of osteoblasts. Furthermore, since these peptides have been extensively investigated for bone tissue engineering, the clinical applications of these peptides for bone regeneration are discussed.
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Affiliation(s)
- Suzane C Pigossi
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP-São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
- Department of Morphology, School of Dentistry, UNESP- São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
| | - Marcell C Medeiros
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP-São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
| | - Sybele Saska
- Department of General and Inorganic Chemistry, Institute of Chemistry, UNESP-São Paulo State University, Professor Francisco Degni St, 55, CEP 14800-900 Araraquara, São Paulo, Brazil.
| | - Joni A Cirelli
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP-São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
| | - Raquel M Scarel-Caminaga
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP-São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
- Department of Morphology, School of Dentistry, UNESP- São Paulo State University, Humaita St, 1680, CEP 14801-903 Araraquara, São Paulo, Brazil.
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Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital. Rev Bras Ortop 2016; 51:521-526. [PMID: 27818972 PMCID: PMC5090956 DOI: 10.1016/j.rboe.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. Methods Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann–Whitney's U tests were used with a 5% level of significance (p < 0.05). Results 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). Conclusion Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).
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Abuomira IEA, Sala F, Elbatrawy Y, Lovisetti G, Alati S, Capitani D. Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame. Strategies Trauma Limb Reconstr 2016; 11:153-159. [PMID: 27660248 PMCID: PMC5069202 DOI: 10.1007/s11751-016-0264-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
Abstract
This retrospective review assesses 55 tibial nonunions with bone loss to compare union achieved with combined Ilizarov and Taylor spatial frames (I–TSF) versus a conventional circular frame with the standard Ilizarov procedure. Seventeen (31 %) of the 55 nonunions were infected. Thirty patients treated with I–TSF were compared with 25 patients treated with a conventional circular frame. In the I–TSF group, an average of 7.6 cm of bone was resected and the lengthening index (treatment time in months divided by lengthening amount in centimeters) was 1.97. In the conventional circular frame group, a mean of 6.5 cm was resected and the lengthening index was 2.1. Consolidation at the docking site and at the regenerate bone occurred in 49 (89 %) of 55 cases after the first procedure. No statistically significant difference was shown between the two groups. Superiority of one modality of treatment over the other cannot be concluded from our data. Application of combined Ilizarov and Taylor spatial frames for bone transport is useful for treatment of tibial nonunion with bone loss. Level of evidence Case series, Level III.
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Affiliation(s)
| | - Francesco Sala
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Yasser Elbatrawy
- Department of Orthopedic Surgery and Traumatology, Al-Azhar University Hospital, Assiut, Egypt
| | - Giovanni Lovisetti
- Department of Orthopedic Surgery and Traumatology, Menaggio Hospital, Menaggio, CO, Italy
| | - Salvatore Alati
- Department of Orthopedic Surgery and Traumatology, Menaggio Hospital, Menaggio, CO, Italy
| | - Dario Capitani
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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Sampaio FMB, Marçal LP, dos Reis DG, Kasuo AW, Fraga CEC, de Moraes FB. Avaliação clínica de pacientes submetidos à distração osteogênica no membro inferior em hospital universitário. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sahu RL, Ranjan R. Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome. Niger Med J 2016; 57:129-33. [PMID: 27226689 PMCID: PMC4872491 DOI: 10.4103/0300-1652.182076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A complex nonunion of the shaft of the tibia is a major cause of morbidity and mortality in patients with lower extremity injuries. AIMS The aim of this study was to evaluate the outcome of the functional and radiological outcome of complex nonunion shaft of tibia, treated by radical debridement, Ilizarov ring fixator with compression and distraction osteogenesis. METHODS From 2005 to 2010, sixty cases of complex nonunion shaft of tibia were included in our study. All infected nonunions were managed by radical debridement, fixed with Ilizarov ring fixator, monofocal/bifocal compression, and distraction osteogenesis. The average duration of follow-up is 36 months (26-50 months). The functional evaluation was done by using Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and bone union with serial radiographs. RESULTS All patients had a successful union. The mean time for union was 7 months (5-9 months). The mean time of fixator removal is 12 months (8-14 months). Every patient had pin tract infections which were successfully treated with oral antibiotics. Four patients had an equinus deformity, one patient had insignificant limb shortening (1.5 cm), and three patients had soft tissue dystrophy. Using the ASAMI scoring system, we obtained 45 excellent, 10 good, 3 fair, and 2 poor functional results. CONCLUSIONS The Ilizarov technique for complex nonunions has a high rate of success in achieving union and eradicating infection, bone loss, and malalignment. Radical debridement is the key step to control bone infection.
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Affiliation(s)
- Ramji Lal Sahu
- Department of Orthopaedics, SMS and R, Sharda University, Noida, Uttar Pradesh, India
| | - Rajni Ranjan
- Department of Orthopaedics, SMS and R, Sharda University, Noida, Uttar Pradesh, India
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Carlier A, Lammens J, Van Oosterwyck H, Geris L. Computational modeling of bone fracture non-unions: four clinically relevant case studies. IN SILICO CELL AND TISSUE SCIENCE 2015; 2:1. [PMID: 26709368 PMCID: PMC4684906 DOI: 10.1186/s40482-015-0004-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/11/2015] [Indexed: 12/02/2022]
Abstract
The human skeleton has a remarkable regeneration capacity. Nevertheless, 5-10 % of the bone fractures fails to heal and develops into a non-union which is a challenging orthopedic complication requiring complex and expensive treatment. This review paper will discuss four different computational models, each capturing a particular clinical case of non-union: non-union induced by reaming of the marrow canal and periosteal stripping, non-union due to a large interfragmentary gap, non-union due to a genetic disorder [i.e. NF1 related congenital pseudoarthrosis of the tibia (CPT)] and non-union due to mechanical overload. Together, the four computational models are able to capture the etiology of a wide range of fracture non-union types and design novel treatment strategies thereof. Further research is required to corroborate the computational models in both animal and human settings and translate them from bench to bed side.
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Affiliation(s)
- Aurélie Carlier
- />Biomechanics Section, KU Leuven, Celestijnenlaan 300 C, PB 2419, 3000 Leuven, Belgium
- />Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, O&N 1, Herestraat 49, PB 813, 3000 Leuven, Belgium
| | - Johan Lammens
- />Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, O&N 1, Herestraat 49, PB 813, 3000 Leuven, Belgium
- />Department of Orthopaedics, University Hospitals of KU Leuven, KU Leuven, Weligerveld 1-blok 1, 3212 Pellenberg, Belgium
| | - Hans Van Oosterwyck
- />Biomechanics Section, KU Leuven, Celestijnenlaan 300 C, PB 2419, 3000 Leuven, Belgium
- />Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, O&N 1, Herestraat 49, PB 813, 3000 Leuven, Belgium
| | - Liesbet Geris
- />Biomechanics Section, KU Leuven, Celestijnenlaan 300 C, PB 2419, 3000 Leuven, Belgium
- />Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, O&N 1, Herestraat 49, PB 813, 3000 Leuven, Belgium
- />Biomechanics Research Unit, Department of Aerospace and Mechanical Engineering, University of Liege, Chemin des Chevreuils 1-BAT 52/3, 4000 Liege 1, Belgium
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Treatment of large calvarial defects with bone transport osteogenesis: a preclinical sheep model. J Craniofac Surg 2015; 25:1917-22. [PMID: 25119411 DOI: 10.1097/scs.0000000000000987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Bone transport osteogenesis (BTO), distraction of a free portion of bone across a defect, offers an autologous solution to large cranial defects that may allow treatment without permanent hardware implantation. This study establishes a sheep model to evaluate the feasibility and distraction kinetics of BTO. METHODS Subtotal cranial defects (3.5 × 3.5 cm) were created in 10 young adult sheep and a transport segment (3.5 × 2 cm) traversed the defect at varying distraction rates (0, 0.5, 1.0, and 1.5 mm/day) using semi-buried cranial distractors. After a 6-week consolidation period, sheep were euthanized and the resultant bone was analyzed by CT, histology, and mechanical testing. RESULTS Gross examination, histology, and 3D CT revealed that control animals had fibrous nonunion whereas distraction animals had ossified defects with fibrous nonunion at the distal docking site. There was one premature consolidation in the 0.5 mm/day group. The volume of bony regenerate in the 0.5, 1.0, and 1.5 mm/day distraction rate groups was statistically indistinct (P = 0.16). The mean flexural moduli (MPa) of non-decalcified samples from the control cranium, transport segment, and bone regenerate were found to be 4.50 ± 4.9, 6.17 ± 2.1, and 4.14 ± 4.8, respectively (P = 0.24). CONCLUSIONS This experiment provides proof of concept for BTO for large calvarial defects in a sheep model. Distraction at a rate of 0.5 mm per day may place individuals at higher risk for premature consolidation, but distraction rates did not have significant effects on regenerate quantity or quality. Future work will include the use of curvilinear distraction devices for 3-dimensional contour.
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Compton J, Fragomen A, Rozbruch SR. Skeletal Repair in Distraction Osteogenesis: Mechanisms and Enhancements. JBJS Rev 2015; 3:01874474-201508000-00002. [PMID: 27490473 DOI: 10.2106/jbjs.rvw.n.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jocelyn Compton
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10031
| | - Austin Fragomen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - S Robert Rozbruch
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Biz C, Iacobellis C. Nailing treatment in bone transport complications. Strategies Trauma Limb Reconstr 2014; 9:89-96. [PMID: 25056513 PMCID: PMC4122676 DOI: 10.1007/s11751-014-0196-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/18/2014] [Indexed: 12/31/2022] Open
Abstract
A series of cases of reamed intramedullary nailings carried out after complications in regenerated bone and docking site had occurred in bone transport is presented here. Nine patients (femur = 5; tibia = 4) had treatment with resection after open fractures or infection and underwent bone transport. The mean length of regenerated bone was 9.5 cm (range 6–18 cm). After bone transport, the fixator remained in place for a mean period of 12.8 months (range 8–24 months). In six cases (femur 4; tibia 2), the thickness of the cortical wall of the regenerate column was insufficient, and in two of these, there was, in addition, nonunion of the docking site. In the two tibial cases, nailing was carried out shortly after the fixator had been removed and after refracture of the regenerated bone had occurred due to insufficient cortical thickness. In one femur, nailing was carried out for nonunion of the docking site. Follow-up involved clinical and X-ray checks. The mean follow-up was 3.9 years (range 2–6 years). In all cases, union and with complete corticalization of the regenerate column was observed at an average 6 months after nailing (range 4–11 months). Infection occurred in one tibia 4 months after nailing. The infection was treated with antibiotics, and the nail was subsequently removed. We conclude that nailing is a potential solution for regenerated bone and docking site problems but, if used after prolonged periods of external fixation, may necessitate antibiotic therapy for at least 10 days after the fixator has been removed.
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Affiliation(s)
- C Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Abstract
The advent of stem cell-based therapies makes current models of mandibular distraction osteogenesis unwieldy. We thereby designed an isogenic model of distraction osteogenesis whose purpose was to allow for the free transfer of cells and components between rats. As immune response plays a significant role in healing and prevention of infection, an immune-competent mode is desirable rather than an athymic rat/xenograft model. The purposes of this study were as follows: (1) to replicate established models of distraction osteogenesis in a rodent model using an isogenic rat strain, and (2) to characterize the differences between inbred, isogenic rats and outbred rats in mandibular distraction osteogenesis via radiomorphometry and biomechanical response analysis. We demonstrated successful distraction osteogenesis to 5.1 mm in all Lewis (isogenic) rat mandibles as well as all Sprague-Dawley (outbred) rat mandibles, with no significant difference in volume-normalized radiomorphometrics, trending difference in non-volume-normalized radiomorphometrics and significant differences in biomechanical response parameters. We attribute the differences demonstrated to the decreased size of the Lewis rat mandible in comparison to Sprague-Dawley mandibles. We also provide information with caring with the additional needs of the Lewis rat. Given these differences, we find that Lewis rats function as an excellent model for isogenic mandibular distraction osteogenesis, but data procured may not be comparable between isogenic and nonisogenic models.
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Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. Injury 2014; 45:560-7. [PMID: 24342368 DOI: 10.1016/j.injury.2013.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 11/16/2013] [Accepted: 11/17/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of nonunion has remained a constant challenge. The associated bone defect, shortening, deformity and infection complicate the management. A mono-lateral external fixator may minimise some of the problems frequently encountered in these patients. We report our results of prospectively evaluated 37 consecutive patients regarding nonunion of lower-extremity long bones managed using a mono-lateral external fixator. PATIENTS AND METHODS A total of 37 patients (7 femurs and 30 tibias), mean age 36 years, were stabilised using a mono-lateral fixator for nonunion of long bones. The mean time since injury was 8 months. Fifteen cases were infected and they received debridement and antibiotic treatment as per culture and sensitivity reports. In cases where the bone gap or shortening was >3 cm in the tibia and >5 cm in the femur, corticotomy and bone transport (bifocal procedure) was done and in the remaining cases, only compression-distraction (monofocal procedure) was done. The bone and functional results were assessed at the end of treatment according to the criteria described by Paley et al. RESULTS Union was achieved in 34 cases (91.9%). The average time for union was 5 months. Five cases were treated with the bifocal method and 32 cases were treated with the monofocal method. The average length gain in the bifocal method was 5.7 cm, mean duration of treatment was 8.2 months and bone healing index (BHI) was 1.44 months cm(-1). In six cases, the monofocal treatment was used for limb lengthening. The average length gain was 1.9 cm, mean duration of treatment was 4.83 months and BHI was 2.5 months cm(-1). Bone grafting was required in two cases at the docking site. The bone results were excellent in 24 cases, good in nine cases, fair in one case and poor in three cases. The functional results were excellent in 27 cases, good in six cases, fair in one case and poor in three cases. The most common complication in this series was pin-tract infection (11.5%). CONCLUSIONS A mono-lateral external fixator is an effective method for treating nonunion in the lower extremity with or without bone loss. The nonunion site can be carefully controlled with simultaneous correction of angulation and length.
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Samuel S, Sait A, Nithyananth M, Oomen AT, Krishnamoorthy VP, Daniel AJ. WITHDRAWN: Distraction osteogenesis using monolateral external fixator for post-traumatic skeletal defects of the femur. Injury 2012:S0020-1383(12)00259-8. [PMID: 22867690 DOI: 10.1016/j.injury.2012.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/10/2012] [Accepted: 06/28/2012] [Indexed: 02/02/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- S Samuel
- Department of Orthopaedics (Unit III), Christian Medical College, Ida Scudder road, Vellore 632004, Tamil Nadu, India.
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Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopaedics and Pediatrics, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
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Zhao ZY, Shao L, Zhao HM, Zhong ZH, Liu JY, Hao CG. Osteogenic Growth Peptide Accelerates Bone Healing during Distraction Osteogenesis in Rabbit Tibia. J Int Med Res 2011; 39:456-63. [PMID: 21672349 DOI: 10.1177/147323001103900213] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Distraction osteogenesis is a valuable treatment method that allows limb lengthening or reconstruction of large bone defects. However, its major disadvantage is the long period required for the consolidation of a distraction callus. Osteogenic growth peptide (OGP) stimulates endochondral bone formation in fracture callus, but its capacity to promote regenerate ossification during distraction osteogenesis has not been evaluated. This study investigated whether intravenously administered OGP accelerated bone healing during distraction osteogenesis in 36 male New Zealand White rabbits, randomized into two groups. The treatment group received OGP (200 ng/kg body weight) in phosphate-buffered saline (PBS), intravenously, each day; the control group received PBS alone. A 15-mm lengthening of the right lower leg was performed using the method of Ilizarov. Evidence from biomechanical, histological and radiographic evaluations demonstrated that systemic OGP treatment promoted optimal new bone formation during distraction osteogenesis in this rabbit model.
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Affiliation(s)
- Z-Y Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - L Shao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - H-M Zhao
- Department of Gynaecology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Z-H Zhong
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - J-Y Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - C-G Hao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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