1
|
Hamiti Y, Abudureyimu P, Lyu G, Yusufu A, Yushan M. Management strategies for Docking Site refractures: a comparative analysis of 19 patient cases. J Orthop Surg Res 2024; 19:430. [PMID: 39054535 PMCID: PMC11270954 DOI: 10.1186/s13018-024-04938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024] Open
Abstract
AIMS This study aimed to compare the clinical effectiveness of intramedullary nailing (IMN), percutaneous external plate fixation (PEPF), and re-applied external fixation (REF) in the treatment of refracture at the consolidated docking site following the removal of external fixation in patients with tibial defects who had previously undergone the Ilizarov bone transport technique. METHODS A retrospective review was performed on patients who received IMN, PEPF, or REF for refracture at the consolidated docking site subsequent to the removal of external fixation. A collection of data was made regarding the following parameters: age, gender, defect size, treatment methods, external fixation time (EFT), external fixation index (EFI), time of refracture (TOR) subsequent to fixation removal, and docking reunion time (DRT). Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system and the Lower Extremity Functional Scale (LEFS) questionnaire. RESULTS The study included 14 males and 5 females with an average age of 38.1 ± 8.9 years (range, 26 to 55 years). Etiologies included post-traumatic osteomyelitis in 11 cases and post-traumatic bone loss in 8 cases. The median bone defect was 5.11 ± 0.87 cm (range, 3.8 to 6.8 cm). Following docking site refracture, 6 cases were treated with IMN, 8 with PEPF, and 5 with REF. All patients achieved both satisfactory bone union and functional outcomes, and there was no significant difference in preoperative baseline data or postoperative outcomes among the three groups. CONCLUSION IMN, PEPF, and REF were all demonstrated favorable postoperative bone and functional outcomes, suggesting their reliability as treatment options for managing docking site refracture following external fixation removal.
Collapse
Affiliation(s)
- Yimurang Hamiti
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Patiman Abudureyimu
- Imaging Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Gang Lyu
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, P.R. China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China.
| | - Maimaiaili Yushan
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, P.R. China.
| |
Collapse
|
2
|
Bernstein M, Little MTM, Marecek G. Current Management of Acute and Posttraumatic Critical Bone Defects. J Orthop Trauma 2024; 38:S1-S8. [PMID: 38502596 DOI: 10.1097/bot.0000000000002762] [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: 01/04/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY Limb reconstruction in patients with critical-sized bone defects remains a challenge due to the availability of various technically demanding treatment options and a lack of standardized decision algorithms. Although no consensus exists, it is apparent from the literature that the combination of patient, surgeon, and institutional collaborations is effective in providing the most efficient care pathway for these patients. Success relies on choosing a particular surgical approach that manages infection, soft tissue defects, stability, and alignment. Recent systematic reviews demonstrate high success rates with the following management options: Ilizarov bone transport, Masquelet (induced membrane) technique, cancellous bone grafting, and vascularized bone grafts.
Collapse
Affiliation(s)
- Mitchell Bernstein
- Department of Surgery, McGill University Health Center, Montreal QC, Canada
- Department of Pediatric Surgery, McGill University Health Center, Montreal QC, Canada; and
| | - Milton T M Little
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA
| | - Geoffrey Marecek
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA
| |
Collapse
|
3
|
Seng DWR, Oh CW. Critical size bone defects managed with modern techniques of bone transport: An update. Injury 2024; 55:111341. [PMID: 38244250 DOI: 10.1016/j.injury.2024.111341] [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: 10/24/2023] [Revised: 12/10/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Bone transport is one of several techniques that has been proven to be effective in addressing critical bone loss. While it was first described over 100 years ago, modifications to this technique coupled with advances in technology have allowed us to perform bone transport with higher success rates and reduced complication rates. Modern techniques of bone transport aim to shorten the duration of time an external fixator is utilized to reduce its associated complications and burden to patients. We present an update on modern techniques of bone transport for critical size defects and methods to shorten the external fixation time.
Collapse
Affiliation(s)
- Daniel W R Seng
- Department of Orthopaedic Surgery. Woodlands Health. National Health Group, Singapore
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.
| |
Collapse
|
4
|
Olesen UK, Herzenberg JE, Hindsø K, Singh UM, Petersen MM. Plate-assisted bone-segment transport in the femur with 2 internal lengthening nails: a technical note and a case report. Acta Orthop 2023; 94:466-470. [PMID: 37712251 PMCID: PMC10506739 DOI: 10.2340/17453674.2023.18493] [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] [Received: 08/20/2022] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
A novel technique to resolve large bone defects, using 2 internal lengthening nails (ILNs), one antegrade and one retro-grade, aligned in a custom-made tube is presented. A 28-year-old, healthy, asymptomatic male presented with a slowly growing mass in the left femur.
Collapse
Affiliation(s)
- Ulrik Kähler Olesen
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark.
| | | | - Klaus Hindsø
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| | - Upender Martin Singh
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Limb Reconstruction, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
5
|
Blair JA, Puneky GA, Swaminathan N, Klahs KJ, Davis JM. Tibial Bone Transport With a Single Implant All-Internal Bone Transport Nail. J Orthop Trauma 2023; 37:e294-e300. [PMID: 36730795 DOI: 10.1097/bot.0000000000002513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
SUMMARY A single implant all-internal magnet-driven bone transport nail (BTN-NuVasive Specialized Orthopaedics Inc) has recently been introduced as a treatment method for segmental tibial bone defects. This innovation provides promise in the management of segmental bone defects because it negates numerous complications associated with circular external fixation and the need for multiple implants when considering hybrid plate-assisted bone segment transport constructs. Given the novelty of the BTN, description of the surgical application and patient outcome measures are scarce in the current literature. To date, we have treated 4 patients with an average age of 27 years (range 19-44 years) using the BTN for segmental tibial defects ranging from 50 to 128 mm. We have accumulated data over an average follow-up of 18.07 months (range 12.96-25.13 months), demonstrating good patient tolerance of the device. Three patients successfully completed their treatment course with a calculated average bone healing index of 41.4 days/cm (range 31.41-54.82 days/cm). One patient was noted to experience an asymptomatic docking site nonunion requiring subsequent surgery for nonunion repair. Implant-associated complications included symptomatic implant, axial malalignment, docking site nonunion, and external remote control technical malfunction. Injury-related complications were encountered and noted to include: superficial infection, wound dehiscence, peroneal tendonitis, and joint rigidity. In this study, the authors present a case series using this implant to date and discuss our experiences with the BTN with reference to clinical indications, tibial bone preparation, BTN implantation, transport protocol, docking site procedure, and clinical/radiographic outcomes.
Collapse
Affiliation(s)
- James A Blair
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia; and Medical Student, Medical College of Georgia at Augusta University, Augusta, Georgia; and Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Novel Techniques and Future Perspective for Investigating Critical-Size Bone Defects. Bioengineering (Basel) 2022; 9:bioengineering9040171. [PMID: 35447731 PMCID: PMC9027954 DOI: 10.3390/bioengineering9040171] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 01/31/2023] Open
Abstract
A critical-size bone defect is a challenging clinical problem in which a gap between bone ends will not heal and will become a nonunion. The current treatment is to harvest and transplant an autologous bone graft to facilitate bone bridging. To develop less invasive but equally effective treatment options, one needs to first have a comprehensive understanding of the bone healing process. Therefore, it is imperative to leverage the most advanced technologies to elucidate the fundamental concepts of the bone healing process and develop innovative therapeutic strategies to bridge the nonunion gap. In this review, we first discuss the current animal models to study critical-size bone defects. Then, we focus on four novel analytic techniques and discuss their strengths and limitations. These four technologies are mass cytometry (CyTOF) for enhanced cellular analysis, imaging mass cytometry (IMC) for enhanced tissue special imaging, single-cell RNA sequencing (scRNA-seq) for detailed transcriptome analysis, and Luminex assays for comprehensive protein secretome analysis. With this new understanding of the healing of critical-size bone defects, novel methods of diagnosis and treatment will emerge.
Collapse
|
8
|
Zuckerman LM, Scolaro JA, Gardner MP, Kern T, Lanz P, Quinnan SM, Watson JT, Rölfing JD. Technical considerations for the management of segmental osseous defects with an internal bone transport nail. Expert Rev Med Devices 2022; 19:203-211. [PMID: 35289241 DOI: 10.1080/17434440.2022.2054336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Traditionally, distraction osteogenesis has been accomplished with an external fixator. All internal transport utilizing magnetic intramedullary nails is a newer technique for bone reconstruction. The Precice Bone Transport Nail is a new implant that allows for noninvasive transport via a magnetically driven motor. AREAS COVERED This report describes the function of the Bone Transport Nail along with the technical considerations on how to successfully manage bone defects with this new technology. Appropriate use of the nail, preoperative planning, intraoperative considerations, and postoperative management are discussed in detail. EXPERT OPINION The Precice Bone Transport Nail utilizes the technology of the original Precice nail to provide an all-internal option for reconstruction of intercalary defects. This obviates the need for an additional plate with a standard Precice nail when performing bone transport and allows for a less invasive option that decreases operating room time. It provides a more cosmetic result than external fixation and avoids the risks of pin tract infection. Preoperative planning is essential to appropriate execution of the operative procedure and to perform a successful transport. A thorough understanding of the nail design and limitations are a prerequisite as this implant is significantly different from a standard intramedullary nail.
Collapse
Affiliation(s)
- Lee M Zuckerman
- Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - John A Scolaro
- Department of Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Matthew P Gardner
- Department of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Thomas Kern
- Department of Orthopaedic Surgery, BG Hospital Murnau, Murnau am Staffelsee, Germany
| | - Philipp Lanz
- Departments of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | - Stephen M Quinnan
- The Paley Orthopedic and Spine Institute, St. Mary's Medical Center, West Palm Beach, FL, USA
| | - J Tracy Watson
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | |
Collapse
|
9
|
Reconstructive Options for Tibial Bone Defects. J Am Acad Orthop Surg 2021; 29:901-909. [PMID: 34288887 DOI: 10.5435/jaaos-d-21-00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Segmental bone defects of the tibia are amenable to multiple treatment options including classic bone transport, shortening and then lengthening, induced membrane technique, transport over a nail, free fibular grafting, and medial transport of the ipsilateral fibula. These treatment options have relative advantages and disadvantages, depending on defect size, soft-tissue characteristics, the presence or absence of infection, and associated morbidity. Relatively, few large comparative studies exist, and surgeons are left to their own experience and the opinion of experts within the field to guide surgical decision-making.
Collapse
|
10
|
Abstract
This article describes the etiology of segmental bone defects and reviews the options of care, past and present. A brief description of distraction osteogenesis and how the Ilizarov method was used to treat bone defects with circular external fixation leading to the latest method of transport with motorized internal lengthening nails is presented.
Collapse
|
11
|
Fibula-Assisted Segment Transport (FAST) for Defect Reconstruction after Resection of Tibial Adamantinoma: Report of Two Treatments. Case Rep Orthop 2021; 2021:5563931. [PMID: 34007499 PMCID: PMC8110409 DOI: 10.1155/2021/5563931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a “biological plate” and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled “fibula-assisted segment transport” (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.
Collapse
|
12
|
Radiographic evaluation of reconstructive surgery for segmental bone defects: What the radiologist should know about distraction osteogenesis and bone grafting. Clin Imaging 2020; 67:15-29. [DOI: 10.1016/j.clinimag.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
|
13
|
Abstract
OBJECTIVES To evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects. DESIGN Retrospective review of case series. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS We included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients. INTERVENTION The surgical technique was performed in 2 stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed. MAIN OUTCOME MEASUREMENTS Complications as well as radiological and clinical results were evaluated according to the criteria of Paley-Maar. RESULTS Minor complications occurred in 11 patients: pin site problems (9), cellulitis (1), and skin detachment due to Schanz screw (1). Major complications occurred in 8 patients: docking site nonunion (4), early consolidation and Schanz screw failure (1), knee flexion contracture (1), and ankle equinus contracture (2). Four patients had osteomyelitis as residual sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients. CONCLUSIONS The BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
14
|
Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2018; 100:1436-1442. [PMID: 30106829 DOI: 10.2106/jbjs.18.00584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Reggie C Hamdy
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Shriners Hospital for Children, Montreal, Quebec, Canada.,McGill University Health Center, Montreal, Quebec, Canada
| | | | | |
Collapse
|