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Saleh AK, Yusof NM, Attallah AA, Elshal EA, Khames AAA, Ibrahim MNA, Mahmoud MMM, Abdeltawab GE, Abuomira IEAA. Ilizarov External Fixator Versus Orthofix LRS in Management of Femoral Osteomyelitis: A Propensity Score Matched Analysis. Indian J Orthop 2024; 58:1272-1277. [PMID: 39170658 PMCID: PMC11333652 DOI: 10.1007/s43465-024-01208-1] [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: 12/08/2023] [Accepted: 06/18/2024] [Indexed: 08/23/2024]
Abstract
Purpose Treatment of osteomyelitis (OM) is challenging. Ilizarov bone transport is a commonly used technique for management of OM. The recently introduced limb reconstruction system (LRS) has been effectively used for management of OM. It was suggested to be easier in use and less invasive. The present retrospective study aimed to compare LRS and Ilizarov bone transport in management of femoral OM using a propensity score matched analysis. Methods The present retrospective study included 80 consecutive patients with femoral OM. The studied patients were managed either using Ilizarov external fixator (n = 40) or Orthofix LRS (n = 40). The clinical outcome measurements included union time, limb length discrepancy, additional operative procedures, refracture and infection. Results Patients in the LRS group were exposed to significantly higher frequency of bone transport (30.0 versus 15.0%) and lower frequency of acute compression and lengthening (10.0 versus 32.5%). Patients in Ilizarov group had significantly higher frequency of tobramycin pellets as compared to their counterparts. The studied groups were comparable regarding the operative complications including pin-tract infection, non-union at docking site and refracture. Patients in the Ilizarov had significantly shorter time to union (8.2 ± 3.2 versus 11.0 ± 5.6 months, p = 0.012). No statistically significant differences were found between the studied groups regarding the quality-of-life domains. Conclusions Use of Ilizarov external fixator and Orthofix LRS devices proved to be effective and reliable. Their influences on patients' quality appear to be comparable.
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Affiliation(s)
- Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Nazri Mohd Yusof
- Advanced Trauma and Limb Reconstructive Surgery, Kuliyyah of Medicine, International Islamic University of Malaysia, Kuala Lumpur, Malaysia
| | - Abdehamid A. Attallah
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ehab Abdelftah Elshal
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | | | | | - Gaber Eid Abdeltawab
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Huang Q, Ma T, Xu Y, Lu Y, Li M, Wang Q, Ren C, Xue H, Li Z, Zhang K. Acute shortening and double-level lengthening versus bone transport for the management of large tibial bone defects after trauma and infection. Injury 2023; 54:983-990. [PMID: 36658026 DOI: 10.1016/j.injury.2023.01.029] [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: 03/15/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to present our experience with a new modified Ilizarov technique of acute shortening and double-level lengthening (ASDL) for the management of large tibial bone defects after trauma and infection and compare it with bone transport (BT). METHODS A retrospective comparative study was performed on 47 patients with large tibial defects after trauma and infection from June 2014 to June 2018. Depending on different Ilizarov methods, these patients were divided into ASDL group (n = 21) and BT group (n = 26). The difference in bone lengthening time, time in frame, external fixation index, docking site healing time were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications encountered in both groups were categorized according to the classification of Paley, including problems (treated nonoperatively), obstacles (treated operatively), and sequelae (unresolved at last). RESULTS All patients were followed for at least two years since the lengthening frame was removed. All cases achieved complete union at the docking site and consolidation of the regenerate callus. The mean bone loss was 8.9 cm (range 6.5-16.0 cm) in ASDL group vs. 10.3 cm (range 5.2-18.5 cm) in BT group. The mean bone lengthening time was 2.4 ± 0.7 months in ASDL group vs. 4.1 ± 1.4 months in BT group (p<0.001); time in frame was 9.1 months (range 7.0-14.5 months) in ASDL group vs. 17.7 months (range 13.5-23.0 months) in BT group (p<0.001); and external fixation index was 1.04 months/cm (range 0.83-1.38 months/cm) in ASDL group vs. 1.91 months/cm (range 1.28-2.70 months/cm) in BT group (p<0.001). The incidence of obstacles occurred in ASDL group was significantly lower than that in BT group (p<0.001). There was no significant difference in the bone (p = 0.635) and functional results (p = 0.293) between the two groups. CONCLUSION Compared with bone transport, our modified technique of acute shortening and double-level lengthening could reduce bone lengthening time, time in frame, external fixation index and postoperative complications. It showed better clinical effects in patients with large tibial bone defects after trauma and infection.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China.
| | - Teng Ma
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China.
| | - YiBo Xu
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Yao Lu
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Ming Li
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Qian Wang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Cheng Ren
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - HanZhong Xue
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Zhong Li
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Hong Hui hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710054, China
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Zhang Z, Zhang C, Guo QF, Ma GP. Single-stage procedures for treatment of traumatic patellar osteomyelitis: A retrospective study of 21 patients. Injury 2022; 53:3486-3493. [PMID: 35882581 DOI: 10.1016/j.injury.2022.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We herein report on a series of 21 patients with traumatic patellar osteomyelitis treated by single-stage surgery, and discuss the specific application of single-stage procedures for traumatic patellar osteomyelitis. METHODS We retrospectively reviewed the medical records of 21 patients with traumatic patellar osteomyelitis treated in our hospital from January 2010 to April 2018. In a single-stage surgery, aggressive debridement was performed together with application of a tissue flap, especially a gastrocnemius flap (for repair of skin/soft tissue defects and treatment of extensor mechanism defects), and internal refixation of the patellar fracture. The knee joint was exercised early after surgery. Long-term follow-up was performed to evaluate the recurrence of osteomyelitis according to clinical and laboratory signs of infection and to measure the active knee range of motion (ROM). RESULTS Single-stage wound treatment was successful in 20 of 21 patients. Treatments included radical debridement together with tissue flap for repair of soft tissue and extensor mechanism defects, and internal refixation of patellar fractures. 14 patients were treated with gastrocnemius flaps. One patient developed recurrent wound infection, which healed after reoperation. At a mean follow-up of 8 ± 2.63 years (range, 3.2-11.4 years), none had developed recurrence. Six patients had nearly full knee ROM (0°-105° to 0°-146°), whereas 11 patients had impaired knee mobility (ROM, 0°-90° to 0°-65°), 3 patients had knee joint stiffness with a ROM of 0°, and 1 patient had knee flexion contracture with a ROM of 78°-130° CONCLUSIONS: Single-stage surgical treatment consisting of various surgical techniques was an acceptable treatment for traumatic patellar osteomyelitis, allowing early exercise of the knee joint. The osteomyelitis did not recur, and most patients' knee ROM was restored to a certain extent, excluding patients with severe damage to the patellar articular surface and inactive functional exercise.
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Affiliation(s)
- Zhan Zhang
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, No.234 Gucui Road, Hangzhou 310012, China.
| | - Chun Zhang
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, No.234 Gucui Road, Hangzhou 310012, China
| | - Qiao Feng Guo
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, No.234 Gucui Road, Hangzhou 310012, China
| | - Gou Ping Ma
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, No.234 Gucui Road, Hangzhou 310012, China
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Du J, Yin Z, Cheng P, Han P, Shen H. Novel piston technique versus Ilizarov technique for the repair of bone defect after lower limb infection. J Orthop Surg Res 2021; 16:704. [PMID: 34863237 PMCID: PMC8642891 DOI: 10.1186/s13018-021-02844-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection. PATIENTS AND METHODS We retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. There were 38 men and three women with a mean age of 43.41 (range, 12-69 years). The infected bone defects involved 36 tibias and five femurs. The piston technique (PT, group A) was used in 12 patients and the Ilizarov technique (IT, group B) in 29 patients. The mean follow-up period was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate bone healing and functional recovery. RESULTS Complete eradication of the infection and union of docking sites were accomplished in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between groups A and B (p = 0.558) (excellent [9 vs. 19], good [3 vs.10]); group A showed better functional outcomes than group B (p < 0.05) (excellent [7 vs. 6], good [4 vs. 12], fair [0 vs. 10] and poor [1 vs. 1]). Pain was the most common complaint during follow-up, and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8), and delayed healing of the joint (0 vs. 3). CONCLUSIONS Satisfactory bone healing can be achieved by using both PT and IT, although PT demonstrated better functional results, lower EFI, and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation.
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Affiliation(s)
- Jiafei Du
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zifei Yin
- Joint Department, Kunshan Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Pengfei Cheng
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pei Han
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Hao Shen
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. .,Orthopaedic Department, Jinjiang Municipal Hospital, Fujian, China.
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Xu YQ, Fan XY, He XQ, Wen HJ. Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases. BMC Musculoskelet Disord 2021; 22:34. [PMID: 33413256 PMCID: PMC7788851 DOI: 10.1186/s12891-020-03894-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. METHODS We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2-18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. RESULTS The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2-2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. CONCLUSION TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.
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Affiliation(s)
- Yong-Qing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Xin-Yu Fan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Xiao-Qing He
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Hong-Jie Wen
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031.
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Bezstarosti H, Metsemakers WJ, van Lieshout EMM, Voskamp LW, Kortram K, McNally MA, Marais LC, Verhofstad MHJ. Management of critical-sized bone defects in the treatment of fracture-related infection: a systematic review and pooled analysis. Arch Orthop Trauma Surg 2021; 141:1215-1230. [PMID: 32860565 PMCID: PMC8215045 DOI: 10.1007/s00402-020-03525-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This systematic review determined the reported treatment strategies, their individual success rates, and other outcome parameters in the management of critical-sized bone defects in fracture-related infection (FRI) patients between 1990 and 2018. METHODS A systematic literature search on treatment and outcome of critical-sized bone defects in FRI was performed. Treatment strategies identified were, autologous cancellous grafts, autologous cancellous grafts combined with local antibiotics, the induced membrane technique, vascularized grafts, Ilizarov bone transport, and bone transport combined with local antibiotics. Outcomes were bone healing and infection eradication after primary surgical protocol and recurrence of FRI and amputations at the end of study period. RESULTS Fifty studies were included, describing 1530 patients, the tibia was affected in 82%. Mean age was 40 years (range 6-80), with predominantly male subjects (79%). Mean duration of infection was 17 months (range 1-624) and mean follow-up 51 months (range 6-126). After initial protocolized treatment, FRI was cured in 83% (95% CI 79-87) of all cases, increasing to 94% (95% CI 92-96) at the end of each individual study. Recurrence of infection was seen in 8% (95% CI 6-11) and amputation in 3% (95% CI 2-3). Final outcomes overlapped across treatment strategies. CONCLUSION Results should be interpreted with caution due to the retrospective and observational design of most studies, the lack of clear classification systems, incomplete data reports, potential underreporting of adverse outcomes, and heterogeneity in patient series. A consensus on classification, treatment protocols, and outcome is needed to improve reliability of future studies.
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Affiliation(s)
- H Bezstarosti
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - E M M van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - L W Voskamp
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K Kortram
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M A McNally
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - L C Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ma Y, Yin Q, Wu Y, Wang Z, Sun Z, Gu S, Rui Y, Han X. Retraction of transporting bone segment during Ilizarov bone transport. BMC Musculoskelet Disord 2020; 21:704. [PMID: 33106160 PMCID: PMC7590790 DOI: 10.1186/s12891-020-03702-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. METHODS The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. RESULTS Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance(p < 0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance(p > 0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p < 0.05), but the transport distance was not (p > 0.05). CONCLUSION The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.
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Affiliation(s)
- Yunhong Ma
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Zongnan Wang
- Department of Orthopaedics, Shuyang People's Hospital, Suqian, 223000, Jiangsu, China
| | - Zhenzhong Sun
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Xiaofei Han
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
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Chiu YC, Chen IC, Yang SC, Kuo SM, Kao YH, Jou IM, Tu YK. Using antibiotic cement nail with multiple screws fixation as a single-stage salvage procedure for patient with infected tibiotalocalcaneal arthrodesis: A case report. J Orthop Surg (Hong Kong) 2020; 28:2309499019899572. [PMID: 31994966 DOI: 10.1177/2309499019899572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tibiotalocalcaneal (TTC) arthrodesis with retrograde nail is a widely used treatment option for severe ankle arthropathy. With inherent biomechanical benefits in axial loading and strong bending stiffness, high union rate and good clinical outcomes have been reported in the literature. However, some undesired complications, such as osteomyelitis or implant failure, can develop after this procedure. Herein, we report the case of an 86-year-old man with right ankle osteomyelitis after TTC arthrodesis with retrograde nail. After removing the previous implants and extensive debridement, we used an antibiotic cement nail with multiple screws fixation as a salvage procedure in the same operation. The patient fully recovered without further surgical treatment.
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Affiliation(s)
- Yen-Chun Chiu
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - I-Chien Chen
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Shih-Chieh Yang
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Shyh-Ming Kuo
- Department of Biomedical Engineeing, I-Shou University, Kaohsiung
| | - Yu-Hsien Kao
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - I-Ming Jou
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Yuan-Kun Tu
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
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艾尼孜尔· 亚, 阿里木江· 阿, 买买艾力· 玉, 任 鹏, 马 创, 艾合买提江· 玉. [Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:862-868. [PMID: 32666729 PMCID: PMC8180421 DOI: 10.7507/1002-1892.201912034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the effectiveness of trifocal bone transport by using monolateral rail system in the treatment of bone defects caused by post-traumatic tibial osteomyelitis. METHODS The clinical data of 28 patients with tibial defects caused by post-traumatic osteomyelitis treated with trifocal bone transport technique by using monolateral rail system between January 2012 and June 2017 were retrospectively analyzed. There were 26 males and 2 females, aged 22-59 years (mean, 41.3 years). The causes of injury included 13 cases of traffic accident injury, 9 cases of falling from height, 4 cases of heavy object injury, and 2 cases of crushing injury. The disease duration was 4.5-17.0 months (mean, 7.1 months). The length of bone defect was 6.5-16.8 cm (mean, 10.3 cm). And the range of soft tissue defect ranged from 3.5 cm×2.0 cm to 18.0 cm×11.0 cm. The bone transporting time, external fixation time, duration of regenerate consolidation, and external fixation index were recorded, and the complications were observed. At last follow-up, the bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of the Ilizarov (ASAMI). RESULTS All patients were successfully followed up after removing the external fixator with an average of 35 months (range, 24-65 months). The bone transporting time was 41-136 days (mean, 60.2 days), the external fixation time was 7.5-20.0 months (mean, 13.4 months), the external fixation index was 1.1-1.9 months/cm (mean, 1.4 months/cm), the duration of regenerate consolidation was 6.0-16.5 months (mean, 10.5 months). Pin tract infection occurred in 12 cases, delayed union on docking site was occurred in 9 cases, axial deviation was observed in 2 cases, poor regenerate consolidation was presented in 1 case, and refracture on docking site after fixator removal was occurred in 1 case. There was no recurrence of infection, amputation, vascular and neurologic complications, and osteofascial compartment syndrome. At last follow-up, according to ASAMI criterion, the bone healing results were excellent in 17 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 85.7%; the functional results were excellent in 15 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 89.3%. CONCLUSION Trifocal bone transport by using monolateral rail system is an effective method in the treatment of bone defect caused by post-traumatic osteomyelitis which can reduce bone transport time, external fixation time, and complications.
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Affiliation(s)
- 亚里坤 艾尼孜尔·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 阿不来提 阿里木江·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 玉山 买买艾力·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 鹏 任
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 创 马
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 玉素甫 艾合买提江·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
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Ferreira N, Tanwar YS. Systematic Approach to the Management of Post-traumatic Segmental Diaphyseal Long Bone Defects: Treatment Algorithm and Comprehensive Classification System. Strategies Trauma Limb Reconstr 2020; 15:106-116. [PMID: 36466309 PMCID: PMC9679593 DOI: 10.5005/jp-journals-10080-1466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Bone defects remain challenging to manage. The wide array of treatment options is a testament no single strategy works in every patient. This is more complex if consideration is given to the status of the host and the soft tissues. The choice of treatment should be based on specific patient requirements after taking all variables into account. MATERIALS AND METHODS We present a comprehensive classification system and treatment algorithm to assist with decision-making in management. All potential treatment modalities including amputation are discussed with their relevant pearls and pitfalls. CONCLUSION The proposed classification system may potentially assists with communication, enable patient stratification for assigning the most appropriate treatment modality and guide reporting of treatment outcomes. HOW TO CITE THIS ARTICLE Ferreira N, Tanwar YS. Systematic Approach to the Management of Post-traumatic Segmental Diaphyseal Long Bone Defects: Treatment Algorithm and Comprehensive Classification System. Strategies Trauma Limb Reconstr 2020;15(2):106-116.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yashwant S Tanwar
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Reconstruction of Bone Defect Combined with Massive Loss of Periosteum Using Injectable Human Mesenchymal Stem Cells in Biocompatible Ceramic Scaffolds in a Porcine Animal Model. Stem Cells Int 2019; 2019:6832952. [PMID: 31871469 PMCID: PMC6906857 DOI: 10.1155/2019/6832952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/30/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022] Open
Abstract
Clinically, in patients who sustain severe open fractures, there is not only a segmental bone defect needed to be reconstructed but also insufficient healing capacity due to concomitant damages to the periosteum and surrounding soft tissues. For studying the reconstruction of bone defects associated with massive loss of periosteum and surrounding soft tissues, there are no well-established preclinical models in large animals in the literature. The purpose of the study was to generate a large animal model of bone defect with massive periosteum loss and to adopt a tissue engineering approach to achieve rapid bony union with stem cells and biomaterials. In this study, a bone defect with massive periosteum stripping was generated in pigs, which was followed by emptying nearby canal marrow including fat and cancellous bone. The stripped periosteum was a mimic to the situation in the Gustilo type 3 open fractures. Bone defects were then reconstructed by impacting the biocompatible ceramic scaffold, morselized tricalcium phosphate (TCP) loaded with human adipose tissue-derived mesenchymal stem cells (hMSCs). Radiological and pathological assessments indicated that TCP and hMSCs synergistically promoted bone healing with increased lamination and ingrowth of vessels. Both bridging periosteum formation and gap filling were induced rapidly. In conclusion, a porcine model of segmental bone loss with damage of surrounding periosteum was created. Reconstruction of such defects with hMSCs and TCP achieved rapid union of bone defects associated with massive periosteal stripping.
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12
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Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol 2019; 20:22. [PMID: 30993461 PMCID: PMC6468024 DOI: 10.1186/s10195-019-0527-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Critical-sized bone defects of the tibia are complex injuries associated with significant problems that are difficult to treat, and they are associated with a significant burden of disease in clinical practice; however, the treatment of these cases has still been a challenge for orthopedic surgeons. The aim of this review was to evaluate the current available studies reporting on classical Ilizarov methods in the treatment of infected or noninfected critical-sized bone defects of the tibia, and to perform an analysis of treatment period and complications. Methods This is a narrative review based on a comprehensive literature search among the studies in Pubmed, Scopus and Web of Science articles. The studies included were written in the English language or translated to English and they were published between 2008 and 2018. They were appraised with narrative data synthesis. The primary outcome measures were the external fixation time (EFT), bone union rate, and bone and functional results. Secondary outcomes were complications including docking site problems and solutions. The heterogeneity of the data in the studies which were taken into consideration allowed a narrative analysis. Results Twenty-seven articles with 619 patients were included in this study. These included 6 prospective and 21 retrospective case series. Mean age was 36.1 (range 13–89) years. Of the cases, 88.8% were infected and the remaining 11.2% were noninfected. The external fixation time was 10.75 (range 2.5–23.2) months. The mean bone union rate was 90.2% (range 77–100)%. Radiographic outcome measures were reported in 20 studies. Functional outcome measures were reported in 18 studies. ASAMI (Association for the Study of the Method of Ilizarov) criteria are useful and give reproducible data on patient outcome measurements. Data collected from these studies showed excellent radiological outcomes in 303, good in 143, fair in 31, and poor in 25 patients. Functional outcomes were excellent in 200, good in 167, fair in 58, and poor in 19, where reported. The excellent and good rate in bone results and functional results were 88.8% and 82.6%, respectively. The poor rate in bone results and functional results were 5% and 4.5%. Mean complication rate per patient was 1.22 (range 3–60). The most common complication was pin tract infection (PTI). Its occurrence was 46.6%. Joint stiffness followed PTI with a 25% incidence. The rates of refracture, malunion, infectious recurrence, and amputation, were 4%, 8.4%, 4.58%, and 1%, respectively. Conclusions This narrative review shows that the patients with infected or noninfected critical-sized tibial bone defects 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 or noninfected tibial bone defects. The small number of cases in some studies, the absence of homogenity between studies and the fact that most data available are derived from retrospective studies are some of the difficulties encountered in the evaluation of evidence. Level of evidence V.
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Affiliation(s)
- Kemal Aktuglu
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey.
| | - Kubilay Erol
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey
| | - Arman Vahabi
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey
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13
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Lou TF, Wen G, Wang CY, Chai YM, Han P, Yin XF. L-shaped corticotomy with bone flap sliding in the management of chronic tibial osteomyelitis: surgical technique and clinical results. J Orthop Surg Res 2019; 14:47. [PMID: 30755228 PMCID: PMC6373117 DOI: 10.1186/s13018-019-1086-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We described the use of the technique of L-shaped corticotomy with bone flap sliding to treat chronic osteomyelitis of the tibia in eight patients and presented the preliminary results. METHODS L-shaped corticotomy with bone flap sliding was performed in eight patients between 2007 and 2014. All patients had chronic tibial osteomyelitis involving the anterior tibial cortex with intact and healthy posterior cortex. The size of bone defects following sequestrectomy and radical debridement was 8.1 cm on average. One patient required a latissimus dorsi flap. The mean follow-up period was 34.1 months. The functional and bone results were evaluated at the time of the latest follow-up. RESULTS Complete eradication of infection and union of docking sites were achieved in all patients. Functional results were judged excellent in five patients and good in the rest three patients. Bone results were graded as excellent in all cases. The mean external fixation time was 169.9 days and external fixation index was 21.2 days/cm. Pain was the most common complaint that we faced during lengthening. Pin tract infections were observed in four patients, and mild transient stiffness of ankle joint was observed in three patients. CONCLUSIONS We have found this technique to be safe and effective, significantly diminishing the external fixation index. The earlier removal of the external fixator may result in increased patient comfort, a reduced complication rate, and a rapid and convenient rehabilitation.
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Affiliation(s)
- Teng-Fei Lou
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Gen Wen
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Chun-Yang Wang
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yi-Min Chai
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Pei Han
- Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
| | - Xiao-Fan Yin
- Orthopaedic Department, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
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Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA, Metsemakers WJ, Verhofstad MHJ. Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg 2019; 139:61-72. [PMID: 30343322 PMCID: PMC6342870 DOI: 10.1007/s00402-018-3048-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Standardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients. METHODS A comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated. RESULTS The search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies. CONCLUSIONS This extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.
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Affiliation(s)
- H. Bezstarosti
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E. M. M. Van Lieshout
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - L. W. Voskamp
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - K. Kortram
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - W. Obremskey
- 0000 0001 2264 7217grid.152326.1Vanderbilt University, Nashville, USA
| | - M. A. McNally
- 0000 0001 0440 1440grid.410556.3Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - W J. Metsemakers
- 0000 0004 0626 3338grid.410569.fDepartment of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M. H. J. Verhofstad
- 000000040459992Xgrid.5645.2Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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The Ilizarov’s Method in the Management of Infected Tibial Pseudoarthosis Following Intramedullary Nails. Tech Orthop 2015. [DOI: 10.1097/bto.0000000000000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fernandes MBC, Guimarães JAM, Casado PL, Cavalcanti ADS, Gonçalves NN, Ambrósio CE, Rodrigues F, Pinto ACF, Miglino MA, Duarte MEL. The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model. BMC Vet Res 2014; 10:36. [PMID: 24495743 PMCID: PMC3918005 DOI: 10.1186/1746-6148-10-36] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 01/30/2014] [Indexed: 01/21/2023] Open
Abstract
Background The repair of large bone defects is a major orthopedic challenge because autologous bone grafts are not available in large amounts and because harvesting is often associated with donor-site morbidity. Considering that bone marrow stromal cells (BMSC) are responsible for the maintenance of bone turnover throughout life, we investigated bone repair at a site of a critically sized segmental defect in sheep tibia treated with BMSCs loaded onto allografts. The defect was created in the mid-portion of the tibial diaphysis of eight adult sheep, and the sheep were treated with ex-vivo expanded autologous BMSCs isolated from marrow aspirates and loaded onto cortical allografts (n = 4). The treated sheep were compared with control sheep that had been treated with cell-free allografts (n = 4) obtained from donors of the same breed as the receptor sheep. Results The healing response was monitored by radiographs monthly and by computed tomography and histology at six, ten, fourteen, and eighteen weeks after surgery. For the cell-loaded allografts, union was established more rapidly at the interface between the host bone and the allograft, and the healing process was more conspicuous. Remodeling of the allograft was complete at 18 weeks in the cell-treated animals. Histologically, the marrow cavity was reestablished, with intertrabecular spaces being filled with adipose marrow and with evidence of focal hematopoiesis. Conclusions Allografts cellularized with AOCs (allografts of osteoprogenitor cells) can generate great clinical outcomes to noncellularized allografts to consolidate, reshape, structurally and morphologically reconstruct bone and bone marrow in a relatively short period of time. These features make this strategy very attractive for clinical use in orthopedic bioengineering.
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Affiliation(s)
| | | | | | | | | | - Carlos E Ambrósio
- Department of Veterinary Medicine, FZEA, USP, Faculdade de Zootecnia e Engenharia de Alimentos, Departamento de Medicina Veterinária, Universidade de São Paulo, Av, Duque de Caxias Norte, 225, 13635-900 Pirassununga, São Paulo, Brazil.
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