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Wakefield SM, Papakostidis C, Giannoudis VP, Mandía-Martínez A, Giannoudis PV. Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies. Eur J Trauma Emerg Surg 2024; 50:705-721. [PMID: 37921889 PMCID: PMC11249469 DOI: 10.1007/s00068-023-02375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/29/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. As there is a paucity of data directly comparing the outcomes of these techniques, there is no universal agreement on which strategy a surgeon should choose to use. AIMS This systematic review and meta-analysis aimed to summarize the outcomes of both DO and IMT, in terms of primary outcomes (bone union and infection elimination), and secondary outcomes (complication rates and functional outcomes). METHODS A PRISMA strategy was used. Medline, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated using OCEBM and GRADE systems. RESULTS Thirty-two studies with 1136 subjects met the inclusion criteria. With respect to the primary outcomes of interest, union was observed in 94.6% (DO method) and 88.0% (IMT method); this difference, however, was not significant between the two techniques (p = 0.45). In addition, infection elimination rates were also higher in the Ilizarov DO group when compared to Masquelet (Mq) IMT (93.0% vs 80.4% respectively). Again, no significant difference was observed (p = 0.06). For all secondary outcomes assessed (unplanned re-operations, re-fracture rates amputation rate), no statistically significant differences were documented between the treatment options. CONCLUSION This study demonstrated that there is no clinical difference in outcomes for patients treated with Ilizarov DO versus Mq IMT techniques. The evidence base at present is relatively sparse and, therefore, we would recommend for further Level I studies to be conducted, to make more meaningful conclusions.
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Affiliation(s)
- Sophia M Wakefield
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Floor D, Great George Street, Leeds, LS1 3EX, UK
| | - Costas Papakostidis
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Floor D, Great George Street, Leeds, LS1 3EX, UK
| | - Vasileios P Giannoudis
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Floor D, Great George Street, Leeds, LS1 3EX, UK
| | - Alfonso Mandía-Martínez
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Floor D, Great George Street, Leeds, LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Floor D, Great George Street, Leeds, LS1 3EX, UK.
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.
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Akhoundzadeh D, Bloemers FW, Verhofstad MHJ, Schoonmade LJ, Geeraedts LMG. Which surgical technique may yield the best results in large, infected, segmental non-unions of the tibial shaft? A scoping review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02478-y. [PMID: 38446155 DOI: 10.1007/s00068-024-02478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Infected nonunion of the tibia with a large segmental bone defect is a complex and challenging condition for the patient and surgeon. This scoping review was conducted to identify existing evidence and knowledge gaps regarding this clinical scenario. Secondly, the objective of this study was to search for a valid recommendation on the optimal treatment. METHODS A comprehensive search was conducted in the bibliographic databases: PubMed, Embase.com, and Web of Science Core Collection. Studies reporting on bone transport techniques, the Masquelet technique, and vascularized fibular grafts in bone defects greater than 5 cm were included. Bone healing results and functional results were compared according to duration of nonunion, infection recurrence, bone consolidation, complication rate, external fixation time, and time until full weight-bearing. RESULTS Of the 2753 articles retrieved, 37 studies could be included on bone transport techniques (n = 23), the Masquelet technique (n = 7), and vascularized fibular grafts (n = 7). Respective bone union percentages were 94.3%, 89.5%, and 96.5%. The percentages of infection recurrence respectively were 1.6%, 14.4% and 7.0%, followed by respectively 1.58, 0.78, and 0.73 complications per patient. CONCLUSION Bone transport was found to be the most widely studied technique in the literature. Depending on the surgeon's expertise, vascularized fibular grafts may be held as a favourable alternative. This review indicates that further high-quality research on large bone defects ( ≥ 5 cm) in patients with infected tibial nonunions is necessary to gain more insight into the potentially beneficial results of vascularized fibular grafts and the Masquelet technique.
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Affiliation(s)
- Dena Akhoundzadeh
- Department of Surgery, Section Trauma Surgery, Amsterdam UMC, location VUmc, De Boelelaan 1117, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands.
| | - Frank W Bloemers
- Department of Surgery, Section Trauma Surgery, Amsterdam UMC, location VUmc, De Boelelaan 1117, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
| | | | - Linda J Schoonmade
- University Library, VU University, Amsterdam UMC, Amsterdam, Netherlands
| | - Leo M G Geeraedts
- Department of Surgery, Section Trauma Surgery, Amsterdam UMC, location VUmc, De Boelelaan 1117, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
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Diaz-Solano D, Sadri B, Peshkova M, Shpichka A, Smirnova O, Shams R, Timashev P, Vosough M. Advanced Therapeutic Medicinal Products in Bone and Cartilage Defects. Curr Rev Clin Exp Pharmacol 2024; 19:355-369. [PMID: 38275042 DOI: 10.2174/0127724328274436231207062008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
The number of patients with functional loss of bone and cartilage tissue has shown an increasing trend. Insufficient or inappropriate conventional treatments applied for trauma, orthopedic diseases, or other bone and cartilage-related disorders can lead to bone and cartilage damage. This represents a worldwide public health issue and a significant economic burden. Advanced therapeutic medicinal products (ATMPs) proposed promising alternative therapeutic modalities by application of cell-based and tissue engineering approaches. Recently, several ATMPs have been developed to promote bone and cartilage tissue regeneration. Fifteen ATMPs, two related to bone and 13 related to cartilage, have received regulatory approval and marketing authorization. However, four ATMPs were withdrawn from the market for various reasons. However, ATMPs that are still on the market have demonstrated positive results, their broad application faced limitations. The development and standardization of methodologies will be a major challenge in the coming decades. Currently, the number of ATMPs in clinical trials using mesenchymal stromal cells or chondrocytes indicates a growing recognition that current ATMPs can be improved. Research on bone and cartilage tissue regeneration continues to expand. Cell-based therapies are likely to be clinically supported by the new ATMPs, innovative fabrication processes, and enhanced surgical approaches. In this study, we highlighted the available ATMPs that have been used in bone and cartilage defects and discussed their advantages and disadvantages in clinical applications.
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Affiliation(s)
- Dylana Diaz-Solano
- Unidad de Terapia Celular - Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Bahareh Sadri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Maria Peshkova
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Anastasia Shpichka
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Moscow, Russia
| | - Olga Smirnova
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Roshanak Shams
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Xue N, Ding X, Huang R, Jiang R, Huang H, Pan X, Min W, Chen J, Duan JA, Liu P, Wang Y. Bone Tissue Engineering in the Treatment of Bone Defects. Pharmaceuticals (Basel) 2022; 15:ph15070879. [PMID: 35890177 PMCID: PMC9324138 DOI: 10.3390/ph15070879] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Bones play an important role in maintaining exercise and protecting organs. Bone defect, as a common orthopedic disease in clinics, can cause tremendous damage with long treatment cycles. Therefore, the treatment of bone defect remains as one of the main challenges in clinical practice. Today, with increased incidence of bone disease in the aging population, demand for bone repair material is high. At present, the method of clinical treatment for bone defects including non-invasive therapy and invasive therapy. Surgical treatment is the most effective way to treat bone defects, such as using bone grafts, Masquelet technique, Ilizarov technique etc. In recent years, the rapid development of tissue engineering technology provides a new treatment strategy for bone repair. This review paper introduces the current situation and challenges of clinical treatment of bone defect repair in detail. The advantages and disadvantages of bone tissue engineering scaffolds are comprehensively discussed from the aspect of material, preparation technology, and function of bone tissue engineering scaffolds. This paper also summarizes the 3D printing technology based on computer technology, aiming at designing personalized artificial scaffolds that can accurately fit bone defects.
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Affiliation(s)
- Nannan Xue
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Xiaofeng Ding
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Rizhong Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Ruihan Jiang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Heyan Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Xin Pan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Wen Min
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jun Chen
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Pei Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
- Correspondence: (P.L.); (Y.W.); Tel.: +86-(25)-8581-1917 (P.L. & Y.W.)
| | - Yiwei Wang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Concord Repatriation General Hospital, Concord 2137, Australia
- Correspondence: (P.L.); (Y.W.); Tel.: +86-(25)-8581-1917 (P.L. & Y.W.)
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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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[Transverse distraction osteogenesis : New chances for limb salvage?]. Unfallchirurg 2022; 125:282-287. [PMID: 35301552 DOI: 10.1007/s00113-022-01156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
Distraction osteogenesis (DO) is a technique that can be successfully used to treat leg length discrepancies and to reconstruct long defects of bone. By gradual distraction of the bone fragments by approximately 1 mm per day, hypervascularization and an increased bone healing potential (growth stimulus) occur. So far, DO has almost exclusively been used longitudinally to generate new biologically active bone. Chronic wounds, ulcers and osteitis, especially in the region of the foot, are always a challenge for the treating surgeon, since treatment is tedious, the outcome uncertain and associated with possible loss of the extremity. Transverse distraction osteogenesis (tDO) now uses the growth stimulus of the DO translationally to treat distally located, chronic wounds and thus leads to accelerated wound healing. At the end of the 5‑week treatment, the transversely distracted fragment, located far proximal to the chronic wound, is back in its original location. The biological stimulus has a long-lasting effect, longer than the tDO itself. Further investigations into the mechanisms of action and treatment outcomes of tDO are required. If the previous results are confirmed, tDO may become a game changer and enable the limb salvage for a large proportion of findings that previously required amputation.
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Bachmeier AT, Euler E, Bader R, Böcker W, Thaller PH. Novel approach to estimate distraction forces in distraction osteogenesis and application in the human lower leg. J Mech Behav Biomed Mater 2022; 128:105133. [PMID: 35217291 DOI: 10.1016/j.jmbbm.2022.105133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE In distraction osteogenesis (DO) of long bones, new bone tissue is distracted to lengthen limbs or reconstruct bone defects. However, mechanical boundary conditions in human application such as arising forces are mainly based on limited empirical data. Our aim was the numerical determination of the callus distraction force (CDF) and the total distraction force (TDF) during DO in the tibia of adults to advance the understanding of callus tissue behavior and optimize DO procedures. METHOD We implemented a mathematical model based on an animal experiment to enable the calculation of forces arising while distracting callus tissue, excluding the influence of surrounding soft tissue (muscles, skin etc.). The CDF progression for the distraction period was calculated using the implemented model and varying distraction parameters (initial gap, area, step size, time interval, length). Further, we estimated the CDF based on reported forces in humans and compared the results to our model predictions. In addition, we calculated the TDF based on our CDF predictions in combination with reported resisting forces due to soft tissue presence in human cadavers. Finally, we compared the progressions to in vivo TDF measurements for validation. RESULTS Due to relaxation, a peak and resting CDF is observable for each distraction step. Our biomechanical results show a non-linear degressive increase of the resting and peak CDF at the beginning and a steady non-linear increase thereafter. The calculated resting and peak CDF in the tibial metaphysis ranged from 0.00075 to 0.0089 N and 0.22-2.6 N at the beginning as well as 20-25 N and 70-75 N at the end of distraction. The comparison to in vivo data showed the plausibility of our predictions and resulted in a 10-33% and 10-23% share of resting CDF in the total resting force for bone transport and elongation, respectively. Further, the percentage of peak CDF in total peak force was found to be 29-58% and 27-55% for bone transport and elongation, respectively. Moreover, our TDF predictions were valid based on the comparison to in vivo forces and resulted in a degressive increase from 6 to 125 N for the peak TDF and from 5 to 76 N for the resting TDF. CONCLUSION Our approach enables the estimation of forces arising due to the distraction of callus tissue in humans and results in plausible force progressions as well as absolute force values for the callus distraction force during DO. In combination with measurements of resisting forces due to the presence of soft tissue, the total distraction force in DO may also be evaluated. We thus propose the application of this method to approximate the behavior of mechanical callus properties during DO in humans as an alternative to in vivo measurements.
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Affiliation(s)
- A T Bachmeier
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany; Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany.
| | - E Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - R Bader
- Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - P H Thaller
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
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Kliushin NM, Burnashov SI, Mekki WA, Leonchuk DS, Sudnitsyn AS. Treatment of postoperative tibial chronic osteomyelitis using bone transport techniques; an observational study. J Clin Orthop Trauma 2021; 24:101652. [PMID: 34840946 PMCID: PMC8605267 DOI: 10.1016/j.jcot.2021.101652] [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: 06/16/2021] [Revised: 08/18/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Postoperative Tibial chronic osteomyelitis is one of the most challenging orthopaedic conditions especially when extensive, the anatomy of subcutaneous anteromedial part of the tibia with less soft tissue coverage complicates the situation. The extent of infected tibial part varies in size and duration from one patient to another. We report our experience using Bifocal and Monofocal bone transport techniques with regard to clinical outcome, recurrence of infection and re-fracture rate. METHODS This is a retrospective observational review of 49 patients with postoperative Tibial chronic osteomyelitis which were treated using either Bifocal distraction compression BFDCO technique group I (31 patients) or Monofocal compression osteosynthesis MFCO technique Group II (18 patients). The average age of the patients was (41.6 ± 13.1 years), (range: 17-67 years). Leg length discrepancy was measured in 33 (58.9%) patients with an average of (1.4 ± 1.7 cm). Contracture of the ankle joint and equinus deformity were detected in 36 (64.3%) patients. Pre and Post-operative radiography together with Modified Irzhansky A.A et al. leg functional assessment system were used to assess the functional outcome. RESULTS The time spent in the Ilizarov fixator (External Fixation Index) in the first group was (142 ± 72 days) and in the second group was (75 ± 54 days). The infection recurred in 2 patients (6%) in group I and in 5 patients (28%) in group II. Lack of consolidation or re-fracture within 6 months after the dismantling of the apparatus was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in group II. Lack of consolidation or re-fracture within 6 months after dismantling of the apparatus in group I was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in Group II. The average functional state score (AFSS) in the first group was (12.45 ± 2.41) on admission and increased to (16.16 ± 2.99) on the final follow-up which corresponded to a "good" result. In the second group II the AFSS was (12.11 ± 2.22) on admission and increased to (15.06 ± 2.88) at the final follow-up which corresponded to a "satisfactory" result. CONCLUSION Treatment of Tibial chronic osteomyelitis using either Bifocal or Monofocal bone transport is an effective method. However our results have demonstrated better functional outcome and less infection recurrence and re-fracture rates when using the Bifocal distraction compression technique (BFDCO).
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Chalak A, Singh S, Shetty S, Kale S, Singh P, Ghodke A. A Novel technique of three-ring Ilizarov fixator frame in gap non-union of tibia. J Clin Orthop Trauma 2021; 23:101639. [PMID: 34790557 PMCID: PMC8577492 DOI: 10.1016/j.jcot.2021.101639] [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: 05/23/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Gap non-union of tibia occurring mostly after trauma and many times complicated by infection, is a difficult problem to treat. The study aimed to assess the outcome of the three-ring construct of the Ilizarov fixator frame in the management of gap non-union of the tibia. METHODS This retrospective study included 30 patients of gap non-union of tibia operated from April 2016 to March 2019 with a three-ring Ilizarov fixator frame and follow-up done till March 2021. The mean age was 39.27 (range 10-66) years. The results were assessed by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. MPTA, PPTA, and LDTA after removal of the frame were also measured. RESULTS Out of the total 30 cases, all the patients showed complete union. The Ilizarov fixator was kept for an average period of 11.43 months and the mean defect size was 7.17 (range 2-12) cm. All patients were followed up for an average period of 39.36 (range 24-54) months. According to the ASAMI score bone/radiological results, 27 were classified as excellent, 2 as good, and 1 as poor. Functionally 28 were graded as excellent and the remainder as good. The normal ranges of MPTA, LDTA & PPTA were also achieved in a majority (80%) of patients. CONCLUSION Our results after using only a three-ring Ilizarov fixator frame are almost equivalent to earlier studies and have advantages such as less weight, better patient compliance, superior radiographic visualization, easy mobilization, and reduced costs. Ilizarov ring fixator remains an excellent treatment modality for tibial non-union with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.
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Affiliation(s)
- Ajit Chalak
- Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Sushmit Singh
- Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India,Corresponding author. Senior Resident, Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Sector 5, Nerul, Navi Mumbai - 400 706, Maharashtra, India.
| | - Sunil Shetty
- Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Sachin Kale
- Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Pankaj Singh
- Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Ashok Ghodke
- Department of Orthopaedics, MGM Medical College Hospital, Kamothe, Navi Mumbai, India
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Ye Li, Xu J, Mi J, He X, Pan Q, Zheng L, Zu H, Chen Z, Dai B, Li X, Pang Q, Zou L, Zhou L, Huang L, Tong W, Li G, Qin L. Biodegradable magnesium combined with distraction osteogenesis synergistically stimulates bone tissue regeneration via CGRP-FAK-VEGF signaling axis. Biomaterials 2021; 275:120984. [PMID: 34186235 DOI: 10.1016/j.biomaterials.2021.120984] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 01/05/2023]
Abstract
Critical size bone defects are frequently caused by accidental trauma, oncologic surgery, and infection. Distraction osteogenesis (DO) is a useful technique to promote the repair of critical size bone defects. However, DO is usually a lengthy treatment, therefore accompanied with increased risks of complications such as infections and delayed union. Here, we demonstrated that magnesium (Mg) nail implantation into the marrow cavity degraded gradually accompanied with about 4-fold increase of new bone formation and over 5-fold of new vessel formation as compared with DO alone group in the 5 mm femoral segmental defect rat model at 2 weeks after distraction. Mg nail upregulated the expression of calcitonin gene-related peptide (CGRP) in the new bone as compared with the DO alone group. We further revealed that blockade of the sensory nerve by overdose capsaicin blunted Mg nail enhanced critical size bone defect repair during the DO process. CGRP concentration-dependently promoted endothelial cell migration and tube formation. Meanwhile, CGRP promoted the phosphorylation of focal adhesion kinase (FAK) at Y397 site and elevated the expression of vascular endothelial growth factor A (VEGFA). Moreover, inhibitor/antagonist of CGRP receptor, FAK, and VEGF receptor blocked the Mg nail stimulated vessel and bone formation. We revealed, for the first time, a CGRP-FAK-VEGF signaling axis linking sensory nerve and endothelial cells, which may be the main mechanism underlying Mg-enhanced critical size bone defect repair when combined with DO, suggesting a great potential of Mg implants in reducing DO treatment time for clinical applications.
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Affiliation(s)
- Ye Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Regenerative Medicine and Health, Hong Kong Institute of Science & Innovation, Chinese Academy of Science, China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jie Mi
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xuan He
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qi Pan
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lizhen Zheng
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Regenerative Medicine and Health, Hong Kong Institute of Science & Innovation, Chinese Academy of Science, China
| | - Haiyue Zu
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ziyi Chen
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bingyang Dai
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xu Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qianqian Pang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Zou
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liangbin Zhou
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Le Huang
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenxue Tong
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gang Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics & Traumatology and Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health, The Chinese University of Hong Kong, Hong Kong SAR, China; CHUK Hong Kong - Shenzhen Innovation and Technology Institute (Futian), China.
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11
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Pawik Ł, Pajchert-Kozłowska A, Szelerski Ł, Żarek S, Górski R, Pawik M, Fink-Lwow F, Morasiewicz P. Assessment of Lower Limb Load Distribution in Patients Treated with the Ilizarov Method for Tibial Nonunion. Med Sci Monit 2021; 27:e930849. [PMID: 34045428 PMCID: PMC8168284 DOI: 10.12659/msm.930849] [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] [Indexed: 11/09/2022] Open
Abstract
Background Successful treatment of tibial nonunion should lead to a complete bone union, lack of pain, and pathological mobility of the lower extremity, as well as to the achievement of satisfactory joint mobility and muscle strength, which in turn improves its biomechanics. The objective of this study was to assess the load placed on the lower limbs in patients subjected to treatment with the Ilizarov method due to aseptic tibial nonunion. Material/Methods This research involved 24 participants (average age, 55 years). All were diagnosed with aseptic tibia nonunion and treated with the Ilizarov external fixator between 2000 and 2017. The control group was matched to the treated group in terms of sex and age. This study used pedobarography evaluation to assess lower limb load distribution. Results No differences were found in the distribution of the load over the entire foot or of the forefoot and hindfoot of the treated limb in comparison to the non-dominant limb of the controls, or in the healthy limb of the treated group compared to the dominant limb of the control group. Similarly, differences in load distribution between the operated and healthy limbs of the treated group were insignificant. Conclusions Patients subjected to treatment with the Ilizarov external fixator for aseptic tibial nonunion show symmetrical load distribution on both lower limbs following treatment, which does not differentiate them in this respect from healthy individuals. Treated patients presented with a symmetrical distribution of the load on the lower extremities over the entire foot surface, including the forefoot and hindfoot. Finally, the Ilizarov external fixator enables restoration of correct static biomechanics of the treated limbs over the period of aseptic tibial nonunion therapy.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy in Motor Disorders and Dysfunctions, University School of Physical Education in Wrocław, Wrocław, Poland
| | | | - Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Malwina Pawik
- Department of Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Felicja Fink-Lwow
- Department of Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopedic and Traumatologic Surgery, Wrocław Medical University, Wrocław, Poland.,Department of Orthopedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Opole, Poland
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12
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Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084217. [PMID: 33923430 PMCID: PMC8073631 DOI: 10.3390/ijerph18084217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
Background: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension. Research question: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals. Methods: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters. Results: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001. Significance: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.
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13
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Szelerski Ł, Pajchert Kozłowska A, Żarek S, Górski R, Mochocki K, Dejnek M, Urbański W, Reichert P, Morasiewicz P. A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia. Arch Orthop Trauma Surg 2021; 141:879-889. [PMID: 32778920 PMCID: PMC8049889 DOI: 10.1007/s00402-020-03571-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. MATERIALS AND METHODS This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008-2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. RESULTS The mean age at the start of treatment was 46.7 years (11-84 years). The mean follow-up period was 7 years (2-12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8-20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. CONCLUSIONS All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7-100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.
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Affiliation(s)
- Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Andżelika Pajchert Kozłowska
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Karol Mochocki
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Maciej Dejnek
- Division of Sport Medicine, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland
| | - Wiktor Urbański
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Paweł Reichert
- Division of Sport Medicine, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland.
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14
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Bachmeier AT, Euler E, Bader R, Böcker W, Thaller PH. Novel method for determining bone dimensions relevant for longitudinal and transverse distraction osteogenesis and application in the human tibia and fibula. Ann Anat 2020; 234:151656. [PMID: 33278581 DOI: 10.1016/j.aanat.2020.151656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In distraction osteogenesis (DO) of long bones, new bone tissue is formed and distracted to lengthen limbs or reconstruct bone defects. However, certain anthropometric quantities relevant for biomechanical modelling of DO are unknown, such as areas where new bone tissue is formed. We developed a novel method to facilitate the determination of these distraction areas (DA), which we applied in the tibia and fibula of adults for longitudinal and transverse DO to advance knowledge of anatomical boundary conditions. METHODS CT data sets of 21 adult human tibiae and 24 fibulae were selected for investigation. Volumetric models were created utilizing image segmentation. The DA for longitudinal DO was determined in a CAD environment using the total bone cross section in the proximal, central and distal diaphysis of the tibia and fibula. Additionally, the medullary canal area was determined in the fibula. Furthermore, we measured the total DA and medullary canal DA for transverse distraction using a longitudinally split fibula with an osteotomy length of 8, 12, 16 and 20 cm. The osteotomy plane was oriented in medial and anteromedial direction. Finally, Spearman analyses were conducted to assess the correlation between bone length and DA. RESULTS For longitudinal DO, the mean total DAs were 878, 535 and 482 mm2 in the tibia and 132, 153, 124 mm2 in the fibula for the proximal, central and distal diaphysis, respectively. Regarding transverse distraction, the mean total DAs for a medial and anteromedial osteotomy plane orientation were 962, 1423, 1868 and 2306 mm2 as well as 925, 1387, 1844, 2279 mm2 for an osteotomy length of 8, 12, 16 and 20 cm, respectively. Weak, positive, and non-significant correlations were observed when correlating bone length and DA in the tibia and fibula. CONCLUSIONS Quantification of DAs and hence distracted callus tissue in DO advances anatomical knowledge and improves biomechanical modelling by adding a parameter which cannot be approximated based on bone length.
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Affiliation(s)
- A T Bachmeier
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany; Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany.
| | - E Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - R Bader
- Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - P H Thaller
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
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15
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Szelerski Ł, Pajchert-Kozłowska A, Żarek S, Górski R, Małdyk P, Morasiewicz P. The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques. Sci Rep 2020; 10:20511. [PMID: 33239730 PMCID: PMC7689488 DOI: 10.1038/s41598-020-77569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022] Open
Abstract
Nonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients's mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.
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Affiliation(s)
- Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Andżelika Pajchert-Kozłowska
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Paweł Małdyk
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.,Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Witosa 26, 41-405, Opole, Poland
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Management of infected nonunions of the femur and tibia with compression-distraction osteogenesis coupled with modern methods at a tertiary military establishment: a prospective case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A. Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years. BMC Musculoskelet Disord 2020; 21:354. [PMID: 32505174 PMCID: PMC7276072 DOI: 10.1186/s12891-020-03335-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatment of large bone defects in lower limbs is a serious challenge for orthopedic surgeons and patients. The bone transport technique using the Ilizarov method has become the main treatment option for the reconstruction of bone defect. However, inevitable difficulties and complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate the effectiveness and complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity. METHODS The study was conducted on 282 patients who underwent bone transport procedures using Ilizarov method at our institution from January 2007 to June 2017. Patient's demographic data, complications and clinical outcomes at minimum of 2 years follow-up were collected and retrospectively analyzed. All difficulties that related to bone transport were documented according to Paley's classification. The clinical outcomes were evaluated using Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at last clinical visit. RESULTS There were 243 male and 39 females with a mean age of 40 years (range 18-65 years). The mean defect was 6.56 ± 2.15 cm, whereas single level transport in 221 cases and double level transport in 61 cases. There were 189 problems, 166 obstacles and 406 complications (257 minor and 149 major complications), and the average complication rate per patients consists of 0.91 minor and 0.53 major complications. The top five complications were pin-site infection (65.96%), axial deviation (40.78%), joint stiffness (23.76%), soft tissue incarceration (22.34%) and delayed union of the docking site (13.48%).The ASAMI bony result was excellent in 233 patients, good in 32, fair in 5 and poor in 12. The ASAMI functional result was excellent in 136 patients, good in 88, fair in 47, poor in 11. CONCLUSION Bone transport is a reliable method for reconstruction of bone defects in the femur and tibia. Awareness of predictable complications is beneficial to prevent or early detection of the expected complication which can improve the risk-benefit balance.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First 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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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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19
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Affiliation(s)
- Meng Mi
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | | | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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20
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Mohammed F, Mankar S, Bhutada G, Sakhare R. Outcomes of ilizarov ring fixation in infected nonunion of tibia. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bifocal Compression-Distraction for Combined Bone and Soft-Tissue Defects in Post-traumatic Tibial Nonunion. J Orthop Trauma 2019; 33:e372-e377. [PMID: 31469753 DOI: 10.1097/bot.0000000000001514] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. DESIGN Nonrandomized prospective, case series, single-center study. SETTING Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt. PARTICIPANTS Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. INTERVENTION Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique. OUTCOME MEASUREMENTS The external fixation index (EFI); functional and bone results; and complication rates. RESULTS All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups. CONCLUSIONS Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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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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Mahajan RK, Srinivasan K, Singh M, Jain A, Kapadia T, Tambotra A. Management of Post-Traumatic Composite Bone and Soft Tissue Defect of Leg. Indian J Plast Surg 2019; 52:45-54. [PMID: 31456612 PMCID: PMC6664845 DOI: 10.1055/s-0039-1688097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Management of composite defects of leg following trauma requires a planned ortho-plastic approach right from the outset. Timely, planned intervention results in reduced amputation rates and improved limb salvage and function. Right from the time of presentation of the patient to the emergency with such injury, the process of decision making in terms of salvage or amputation, local flap cover/free flap cover, bone reconstruction first or soft tissue or both combined, come into play. Guidelines on management are unclear for such defects, a literature search yielding various methods being used by different authors. This article is a review of current literature on management of composite leg defects. A summary of the literature search in terms of various management options given by various authors including the rationale, advantages and disadvantages of each strategy has been provided in this article. The management protocol and method followed by the author in his institute for management of such composite defects have been described in detail. The article seeks to provide readers with an understanding of the management strategies so that appropriate method could be chosen to provide best result.
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Affiliation(s)
- Ravi K Mahajan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Krishnan Srinivasan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Mahipal Singh
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Adish Jain
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Taha Kapadia
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Ankush Tambotra
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
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Fahad S, Habib AA, Awais MB, Umer M, Rashid HU. Infected Non-union of Tibia Treated with Ilizarov External Fixator: Our Experience. Malays Orthop J 2019; 13:36-41. [PMID: 31001382 PMCID: PMC6459041 DOI: 10.5704/moj.1903.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.
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Affiliation(s)
- S Fahad
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - A A Habib
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - M B Awais
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - M Umer
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
| | - H U Rashid
- Section of Orthopaedics, Aga Khan University Hospital, Karachi, Pakistan
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Singh AK, Parihar M, Bokhari S. The Evaluation of the Radiological and Functional Outcome of Distraction Osteogenesis in Patients with Infected Gap Nonunions of Tibia Treated by Bone Transport. Open Access Maced J Med Sci 2019; 7:559-566. [PMID: 30894912 PMCID: PMC6420925 DOI: 10.3889/oamjms.2019.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/18/2019] [Accepted: 02/19/2019] [Indexed: 01/13/2023] Open
Abstract
AIM The aims of this investigation were: 1) to study the Functional outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System, and 2) to study the Radiological outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System. METHODS The study was done with 27 patients of infected gap nonunions of the tibia at Sir JJ Hospitals, Mumbai from 2013-2016. After implant removal, if required radical resection of necrotic tissue and fractures were stabilised with Ilizarov or mono-lateral fixator depending on non-union site. Corticotomy was either done proximally or distally. Patients were followed up at monthly intervals for a minimum of 6 months. RESULTS The ASAMI-Bone healing score was Excellent or Good in 86% patients, and Functional score was Excellent or Good in 89% of patients. The commonest problems were of pin tract infection, wire loosening and angulation of the transported segment. CONCLUSION Elderly age, persistent infection, sensory loss in the foot, the stiffness of the knee, and above all the patient's reluctance to go any further given the protracted treatment besides, systemic disorders such as diabetes are all pointers for considering amputation as an alternative.
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Affiliation(s)
| | | | - Syed Bokhari
- Lower Limb Fellow, Wrightington Hospital, United Kingdom
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Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones non-union. INTERNATIONAL ORTHOPAEDICS 2018; 42:2933-2939. [DOI: 10.1007/s00264-018-3924-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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Abstract
OBJECTIVES We present a treatment algorithm comprising 4 Ilizarov methods in managing infected tibial nonunion, using nonunion mobility and segmental defect size to govern treatment choice. DESIGN Decision protocol analysis study. SETTING A university-affiliated teaching hospital. PATIENTS/PARTICIPANTS Seventy-nine patients were treated with 1 of 4 Ilizarov protocols. All patients had undergone at least one previous operation, 38 had associated limb deformity, and 49 had nonviable nonunions. Twenty-six had a new muscle flap at the time of Ilizarov surgery, and 25 had preexisting flaps reused. INTERVENTION Twenty-six cases were treated with monofocal distraction, 19 with monofocal compression, 16 with bifocal compression/distraction, and 18 with bone transport. MAIN OUTCOME MEASUREMENTS The primary outcome measure was the absence of recurrent infection. Secondary outcomes included bone union, complications, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, and any need for further unplanned surgery. RESULTS Infection was eradicated in 76 cases (96.2%) with a mean follow-up duration of 40.8 months (range 6-131). All 3 infection recurrences occurred in the monofocal compression group. Following the initial Ilizarov method alone, union was achieved in 68 cases (86.1%) and was highest among the monofocal distraction (96.2%) and bifocal compression/distraction groups (93.8%). Monofocal compression achieved the lowest union rate (73.7%), significantly lower ASAMI scores, and a refracture rate of 31.6%. Bone transport secured union in 77.8% with a 44.4% unplanned reoperation rate. However, infection-free union was 100% after further treatment. CONCLUSIONS Monofocal compression is not recommended for treating infected, mobile nonunions. Distraction (monofocal or bifocal) was effective and achieved higher rates of union and infection clearance. LEVEL OF EVIDENCE Level III.
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Management of 30 infected nonunited tibial fractures by Ilizarov external fixator with acute shortening distraction technique with consideration of the causative organism. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The aim of this study was to compare the results of treatment of segmental tibial defects in the pediatric age group using an Ilizarov external fixator versus a nonvascularized fibular bone graft. This study included 24 patients (age range from 5.5 to 15 years) with tibial bone defects: 13 patients were treated with bone transport (BT) and 11 patients were treated with a nonvascularized fibular graft (FG). The outcome parameters were bone results (union, deformity, infection, leg-length discrepancy) and functional results: external fixation index and external fixation time. In group A (BT), one patient developed refracture at the regenerate site, whereas, in group B (FG), after removal of the external fixator, one of the FGs developed a stress fracture. The external fixator time in group A was 10.7 months (range 8-14.5) versus 7.8 months (range 4-11.5 months) in group B (FG). In group A (BT), one patient had a limb-length discrepancy (LLD), whereas, in group B (FG), three patients had LLD. The functional and bone results of the Ilizarov BT technique were excellent in 23.1 and 30.8%, good in 38.5 and 46.2, fair in 30.8 and 15.4, and poor in 7.6 and 7.6%, respectively. The poor functional result was related to the poor bone result because of prolonged external fixator time resulting in significant pain, limited ankle motion, whereas the functional and bone results of fibular grafting were excellent in 9.1 and 18.2%, good in 63.6 and 45.5%, fair in 18.2 and 27.2%, and poor in 9.1 and 9.1%, respectively. Segmental tibial defects can be effectively treated with both methods. The FG method provides satisfactory results, with early removal of the external fixator. However, it had a limitation in patients with severe infection and those with LLD. Also, it requires a long duration of limb bracing until adequate hypertrophy of the graft. The Ilizarov method has the advantages of early weight bearing, treatment of postinfection bone defect in a one-stage surgery, and the possibility to treat the associated LLD. However, it has a long external fixation time.
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Khunda A, Al-Maiyah M, Eardley WGP, Montgomery R. The management of tibial fracture non-union using the Taylor Spatial Frame. J Orthop 2016; 13:360-3. [PMID: 27453643 DOI: 10.1016/j.jor.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
We reviewed 40 complex tibial non-unions treated with Taylor Spatial Frames. 39 healed successfully. Using the ASAMI scoring, we obtained 33 excellent, 5 good, 1 fair and 1 poor bone results. The functional results were excellent in 29 patients, good in 8, fair in two and poor in one. Mean patient satisfaction score was 95%. All but one patient would have the same treatment again. 28 of the 36 patients in work when injured, returned to work at the time of their final review. Four patients had an adverse event requiring significant intervention. Average treatment cost was approximately £26,000/patient.
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Affiliation(s)
- A Khunda
- StR Trauma and Orthopaedics, The North Western Deanery, England, UK
| | - M Al-Maiyah
- The James Cook University Hospital, Middlesbrough, England, UK
| | - W G P Eardley
- The James Cook University Hospital, Middlesbrough, England, UK
| | - R Montgomery
- The James Cook University Hospital, Middlesbrough, England, UK
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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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A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur. PLoS One 2015; 10:e0141973. [PMID: 26529606 PMCID: PMC4631548 DOI: 10.1371/journal.pone.0141973] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/15/2015] [Indexed: 01/03/2023] Open
Abstract
Background Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods. Methods A comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI). Bone results (excellent, good, fair and poor rate), functional results (excellent, good, fair and poor rate) and complications were analyzed by Stata 9.0. Findings A total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04–0.12; I2 = 44.1%, P = 0.065) and 10% (95%CI, 0.05–0.14; I2 = 34.7%, P = 0.121) in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%. Conclusions Our systematic review showed that the patients with infected nonunion of tibia and femur treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected nonunion of tibia and femur.
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Wani NB, Syed B. Ilizarov ring fixator in the management of infected non-unions of tibia. SICOT J 2015; 1:22. [PMID: 27163078 PMCID: PMC4849239 DOI: 10.1051/sicotj/2015022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/20/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of the study was to evaluate the effectiveness of debridement and application of Ilizarov ring fixator (IRF) in the management of infected tibial non-unions. PATIENTS AND METHODS Twenty six patients with infected non-unions of tibia were managed by debridement and resection of infected portion ± partial fibulectomy and stabilization by Ilizarov ring fixator. Bone segment transport was done in 18 patients who had greater than 2.5 cm bone defect after debridement. Bone grafting was required in three patients to augment union. RESULTS All fractures united and infection eradicated completely. There were 13 excellent, nine good, and four fair results. Functional results were excellent in nine, good in 11, fair in five and poor in one. Pin site inflammation was the most common problem and occurred in 23 (88%) patients. There were no major complications or neurovascular complications. CONCLUSION We conclude that debridement combined with Ilizarov ring fixator with or without partial fibulectomy is a reliable method of treatment of infected non-unions of tibia.
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Affiliation(s)
- Naveed Bashir Wani
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MS (Orthopaedics), Registrar department of orthopaedics, Government Medical College Srinagar J&K India
| | - Basit Syed
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PG scholar department of orthopaedics, Government Medical College Srinagar J&K India
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Krappinger D, Lindtner R, Zegg M, Dal Pont A, Huber B. Die Masquelet-Technik zur Behandlung großer dia- und metaphysärer Knochendefekte. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:357-68. [DOI: 10.1007/s00064-014-0300-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
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Yin P, Zhang L, Li T, Zhang L, Wang G, Li J, Liu J, Zhou J, Zhang Q, Tang P. Infected nonunion of tibia and femur treated by bone transport. J Orthop Surg Res 2015; 10:49. [PMID: 25889513 PMCID: PMC4415215 DOI: 10.1186/s13018-015-0189-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 01/27/2015] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of this study was to evaluate the effectiveness of the treatment of infected nonunion of tibia and femur by bone transport. Material and methods We retrospectively reviewed 110 patients with infected nonunion of tibia and femur treated by bone transport. Our study included 92 males and 18 females with a mean age of 38.90 years. The site of infected nonunion involved 72 tibias and 38 femurs. The mean length of the bone defects after radical debridement was 6.15 cm (range 3–13 cm). Results The mean follow-up after removal of the apparatus was 23.12 months (14–46 months). Ten patients including seven patients with infected tibia nonunion and three patients with infected femur nonunion were lost to follow-up. All the patients achieved bone union, and no recurrence of infection was observed. The time of bone transport took a mean of 67.50 days (range 33 to 137 days), and the mean external fixation index was 1.48 months/cm (range 1.15–1.71 months/cm). According to Association for the Study and Application of the Method of Ilizarov (ASAMI) classification, bone results were excellent in 68, good in 28, fair in 12, and poor in 2; functional results were excellent in 37, good in 42, fair in 21, and no poor. Conclusions Our study and the current evidence suggested that Ilizarov methods in the treatment of infected nonunion of tibia and femur acquired satisfied results. Radical debridement is the key step to control bone infection.
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Affiliation(s)
- Peng Yin
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China. .,Medical College, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
| | - Lihai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Tongtong Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China. .,Medical College, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Guoqi Wang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Jiantao Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Jianfeng Zhou
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Qun Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China.
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Khan MS, Rashid H, Umer M, Qadir I, Hafeez K, Iqbal A. Salvage of infected non-union of the tibia with an Ilizarov ring fixator. J Orthop Surg (Hong Kong) 2015; 23:52-5. [PMID: 25920644 DOI: 10.1177/230949901502300112] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review outcomes of 24 patients who underwent Ilizarov ring fixation for infected nonunion of the tibia. METHODS Medical records of 21 men and 3 women aged 13 to 74 (mean, 38) years who underwent Ilizarov ring fixation for infected non-union of the tibia were reviewed. The mean bone defect was 3.3 (range, 2-5) cm. The mean time from injury to presentation was 11.9 (range, 1-36) months. The mean number of previous surgeries was 2 (range, 0-14). A local flap was used in 2 patients and a free flap was used in one patient. Nine of the patients underwent Ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for non-union. Patients were assessed using the Association for the Study and Application of the Method of Ilizarov criteria. RESULTS Patients were followed up for a mean of 11 (range, 8-46) months. Functional outcome was excellent in 8 patients, good in 12, fair in 2, and failure in one, whereas bone union outcome was excellent in 6 patients, good in 14, fair in one, and poor in 2. The mean time to union was 8 (range, 3-31) months. The mean external fixation index was 4.2 (range, 1.5-15.7) cm/month. Complications encountered were pin tract infection (n=5), re-fracture (n=2), soft tissue impingement by Ilizarov rings (n=2), recurrence of wound infection (n=1), mal-union (n=1), and mortality (n=1). CONCLUSION Ilizarov ring fixation is a viable option for infected non-union of the tibia. Adequate assessment of bone union is crucial before removal of fixator to prevent re-fracture.
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Affiliation(s)
- Muhammad Shahid Khan
- Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Treatment of antebrachial and crural septic nonunion fractures in dogs using circular external skeletal fixation: a retrospective study. Vet Comp Orthop Traumatol 2014; 27:297-305. [PMID: 24999089 DOI: 10.3415/vcot-13-08-0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 05/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the outcome of treatment of antebrachial and crural septic non-union fractures in dogs using circular external skeletal fixation (CESF), and to document the type and frequency of complications associated with this technique. METHODS The medical records of all dogs with infected antebrachial and crural non-union fractures treated using the methods of Ilizarov at the Department of Animal Pathology of the University of Turin between 2006 and 2011 were retrospectively reviewed. Only dogs in which radiographic and clinical assessment were available at the time of CESF removal were included in the study. RESULTS Twenty-three dogs met the inclusion criteria. Twenty nonunion fractures treated with CESF healed and three did not. The latter three cases underwent amputation of the affected limb. In the 20 dogs that achieved bone union, six had minor complications and five had major complications. The mid-term outcome was judged to be excellent (n = 11), good (n = 6), fair (n = 2), or poor (n = 4). CONCLUSIONS The results of this study support the use of CESF for the management of antebrachial and crural septic nonunion fractures in dogs. Union was achieved in the majority of dogs and the complication rate was acceptable, considering the severity of the nonunion fractures that were managed in this fashion.
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Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J 2014; 95-B:1673-80. [PMID: 24293599 DOI: 10.1302/0301-620x.95b12.32385] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We carried out a systematic review of the literature to evaluate the evidence regarding the clinical results of the Ilizarov method in the treatment of long bone defects of the lower limbs. Only 37 reports (three non-randomised comparative studies, one prospective study and 33 case-series) met our inclusion criteria. Although several studies were unsatisfactory in terms of statistical heterogeneity, our analysis appears to show that the Ilizarov method of distraction osteogenesis significantly reduced the risk of deep infection in infected osseous lesions (risk ratio 0.14 (95% confidence interval (CI) 0.10 to 0.20), p < 0.001). However, there was a rate of re-fracture of 5% (95% CI 3 to 7), with a rate of neurovascular complications of 2.2% (95% CI 0.3 to 4) and an amputation rate of 2.9% (95% CI 1.4 to 4.4).The data was generally not statistically heterogeneous. Where tibial defects were > 8 cm, the risk of re-fracture increased (odds ratio 3.7 (95% CI 1.1 to 12.5), p = 0.036). The technique is demanding for patients, illustrated by the voluntary amputation rate of 1.6% (95% CI 0 to 3.1), which underlines the need for careful patient selection.
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Affiliation(s)
- C Papakostidis
- "G. Hatzikostas" General Hospital, Department of Trauma and Orthopaedics, Makriyianni Av., 45 001, Ioannina, Greece
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Treatment of large posttraumatic tibial bone defects using the Ilizarov method: a subjective outcome assessment. Arch Orthop Trauma Surg 2013; 133:789-95. [PMID: 23463259 DOI: 10.1007/s00402-013-1712-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND The treatment of large posttraumatic tibial bone defects using the Ilizarov method was shown to be successful in several studies. These studies, however, typically focus on the radiological and functional outcome using objective parameters only. The aim of the present study was therefore to assess the objective and subjective outcome of a consecutive series of patients with large posttraumatic tibial bone defects using the Ilizarov method. Additionally, it was our goal to assess the physical and mental stress for the patients and their relatives during the long treatment period and the general health status at final follow-up. METHODS A consecutive series of 15 patients with posttraumatic tibial bone defects of >30 mm after sustaining open tibial fractures and failure of internal fixation was included. The objective outcome was assessed at final follow-up using Paley's criteria. For the assessment of the subjective outcome, all patients were asked to evaluate their satisfaction with the function of the lower leg, the cosmetic appearance and overall outcome as well. The physical and mental stress of the treatment for the patients and the nearest relative of patients were assessed at the time of frame removal using a custom-made questionnaire. The SF-36 was used to evaluate the general health status at final follow-up. RESULTS Solid bone union with stable soft tissue coverage and eradication of infection was achieved in all patients despite a high complication rate. The functional outcome at final follow-up was excellent or good in all patients. The patients' satisfaction with the overall outcome and the function of the lower extremity was high as well. The fear of amputation and complications was the major subjective burden for both the patients and their relatives. The long external fixation time is another relevant issue. CONCLUSION The Ilizarov method is a safe option for the treatment of large posttraumatic tibial bone defects after failure of internal fixation despite the high complication rate. It is essential to comment this to the patients and their relatives prior to the application of the frame increase their compliance with the long and emotionally draining treatment. The Ilizarov method is worth the effort only in patients, who will presumably comply with this treatment option and all of its drawbacks.
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Lavini F, Dall'Oca C, Bartolozzi P. Bone transport and compression-distraction in the treatment of bone loss of the lower limbs. Injury 2010; 41:1191-5. [PMID: 20943220 DOI: 10.1016/j.injury.2010.09.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A clinical series of 17 adult patients operated due to significant by bone loss of the long bones of the lower extremity (3 femurs and 11 tibias), is presented. Their management consisted of 6 bone transports (6 tibias) and 11 compression distraction procedures (3 femurs and 8 tibiae) using monolateral external fixators. Bone loss ranged from 3.9 cm to 14.7 cm. Mean healing time was 301 days with a mean healing index of 45.6 days for cm of lengthening achieved. The clinical and radiological results were excellent in 9, good in 6 and fair in 2 patients according to the utilised criteria of assessment. Consolidation was achieved in all but one patient who developed an aseptic stiff non-union. Two patients developed residual limb-length discrepancy less than 1.5 cm, three tibias ended up with less than 5° of valgus deviation. In two cases the half-pins were re-inserted due to early loosening. In two cases reoperation was needed for late bending of the callus after fixator removal. Three cases of bone transport and 1 case of compression distraction needed bone grafting at the docking site. Bone transport and compression-distraction are effective methods for treating bone loss in the lower extremity. It is suggested that the compression-distraction technique is preferable, since this is associated with a lower incidence of complications than bone transport procedures. The deciding factor, however, is the actual extent of the bone loss.
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Affiliation(s)
- Franco Lavini
- Department of Orthopaedics and Traumatology, Policlinico G. B. Rossi, University of Verona, Italy
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Bumbasirević M, Tomić S, Lesić A, Milosević I, Atkinson HDE. War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method. Arch Orthop Trauma Surg 2010; 130:739-49. [PMID: PMID: 19946693 DOI: 10.1007/s00402-009-1014-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Indexed: 01/01/2023]
Abstract
PATIENTS AND METHODS This single centre retrospective study reviews the outcomes of 30 war-injured patients with established infected tibial nonunion after sustaining grade IIIB open fractures. Patients were treated by radical bony and soft-tissue resection and bone transport using the Ilizarov bifocal technique, without the use of systemic antibiotics or bone grafting. RESULTS The series comprised 29 males and 1 female with a mean age of 30.4 years and a mean nonunion of 8.6 months at index operation. Patients had previously undergone a mean of 1.3 operations (range 1-3), and the mean size of tibial defect was 6.9 cm (range 4-11 cm) post radical debridement. Bony union was achieved at the tibial docking sites after a mean of 4.5 months in 29 patients (97%) and frames were worn for a mean of 9.7 months (range 7.2-15 months), giving a mean fixation index of 1.48 months/cm. One patient failed to unite at their tibial docking site. Soft-tissue transport successfully closed the soft-tissue defects in all but four patients, who required split-skin grafting. According to the Paley scoring system 19 patients had excellent bony results, 10 good and 1 poor; the functional results were excellent in 13 patients, good in 14, fair in 2 and poor in 1; and there were 1.4 complications per patient. Over a mean follow-up of 99 months no patient refractured their reconstruction, developed any symptoms or signs of recurrent infection, or required amputation. CONCLUSION The Ilizarov technique with bone transport continues to be the most versatile, adaptive and effective method of treatment in these complex cases, and can very successfully deal with the associated large soft-tissue and bony defects without the use of routine bone-grafting, systemic antibiotics or soft-tissue flaps.
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Affiliation(s)
- Marko Bumbasirević
- Institute for Orthopaedic Surgery and Traumatology, Clinical Centre for Serbia, Belgrade, Serbia
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Demir B, Gursu S, Oke R, Konya NM, Ozturk K, Sahin V. Shortening and secondary relengthening for chronically infected tibial pseudarthroses with poor soft tissues. J Orthop Sci 2009; 14:525-34. [PMID: 19802663 DOI: 10.1007/s00776-009-1364-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 04/16/2009] [Indexed: 02/05/2023]
Abstract
BACKGROUND The treatment of chronically infected tibial pseudarthroses with poor soft tissues ends with amputation on many occasions. Aggressive débridement of bone and soft tissue and reconstruction of the extremity, performed as a limb salvage procedure, is an alternative treatment option to amputation. METHODS Our patients had a mean age of 42 years. According to the Paley classification, one of the patients had A2 pseudoarthrosis, four had B2, and three had B3. One had localized infection, whereas the other seven had diffuse infection, according to the Cierny-Mader system. The mean duration of the infection was 10.75 years, and the mean number of previous operations was 5.13. The mean shortness was 2.4 cm, and the mean bone defect was 1 cm. RESULTS The mean primary shortening was 8.6 cm, the mean duration of the fixator stay was 9.6 months, and the mean distraction index was 39.1 days/cm. The mean duration of follow-up was 25 months. The bone results were excellent in four cases, good in two, and fair in the other two. The functional results were excellent in one patient, good in six, and fair in one. A total of 11 minor and 3 major complications were seen during the treatment, and one case resulted in amputation. CONCLUSIONS Despite the high rate of complications, our treatment method enabled limb salvage for patients who had previously been candidates for amputation. With this treatment, there is less need for a second operation, and an additional operation is not necessary for soft tissue coverage.
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Affiliation(s)
- Bilal Demir
- Baltalimani Metin Sabanci Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
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The Combined Use of the Ilizarov Method and Microsurgical Techniques for Limb Salvage. Ann Plast Surg 2009; 62:486-91. [DOI: 10.1097/sap.0b013e318189a9e5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Madhusudhan TR, Ramesh B, Manjunath K, Shah HM, Sundaresh DC, Krishnappa N. Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions - a prospective study. J Trauma Manag Outcomes 2008; 2:6. [PMID: 18651977 PMCID: PMC2515289 DOI: 10.1186/1752-2897-2-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 07/23/2008] [Indexed: 11/23/2022]
Abstract
Background Infected non-union of long bones is a problem in the developing countries. Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union. Secondary procedures are often required for correction of bone defects and deformity. Ilizarov method addresses all the above problems simultaneously and offers a panacea for infected non-unions. The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilisation. Aim of the study To know the suitability of this procedure in recalcitrant infected tibial non-unions in the Indian population and the influence of socio-economic factors in the functional outcome. Method of study This was a 3-year prospective study in 22 consecutive patients with an average follow up of 13 months following fracture union. The results were analysed using the ASAMI scoring system. Results Of 22 patients in the study, 13 patients who underwent external bone transport, had an average bone gap of 4 cms [2–11 cms] with an average duration of fixation of 9.3 months [6.5–13 months]. There were 4 excellent, 3 good, 4 fair and 2 poor bony results and 1 excellent, 3 good, 6 fair and 2 poor results. 1 patient was lost for follow up at final functional analysis. 9 patients who underwent internal bone transport had an average bone gap of 5.4 cms [1.5–9 cms] with an average duration of fixation of 8.5 months [4–11 months]. There were 3 good 4 fair and 2 poor bony results and 1 good, 3 fair, and 2 poor functional results. Good to excellent results were witnessed in well-motivated patients with adequate social and financial support. Patients with fair to poor results preferred amputation to limb salvage despite the fact that they retained their limbs. Conclusion Treatment of infected non-unions of Tibia with Ilizarov ring fixation is effective but for optimal results the treatment needs to be individualised by the treating surgeon with due consideration of the socio-economic factors.
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Kumar A, Khan SA, Yadav CS, Nag HL. Locking compression plate in treatment of forearm fractures: a prospective study. J Orthop Surg (Hong Kong) 2007; 15:121. [PMID: 17429135 DOI: 10.1177/230949900701500128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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