A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia

Deng, Zhibo; Mu, Yuexi; Sun, Xianding; Xu, Yongqing; Li, Fubing; Liang, Yin

doi:10.1155/2021/6668617

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…The Masquelet technique avoids the patient from carrying a heavy circular external fixator, but this technique has higher requirements for the integrity of the soft tissue around the bone defect and requires at least 2 surgical treatments ( 37 ). This technique is often limited due to limited bone volume in the donor site, and is associated with risks such as recurrence of infection, failure of revascularization, and ossification of the transplanted bone region and cannot correct the limb deformity that appears during treatment ( 38 ). Vascularized fibula transplantation requires a high level of microsurgical techniques, the amount of bone supply is limited, and also can cause secondary injury to the donor site.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

et al. 2023

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PurposeThe rail fixator can improve the treatment outcome and provide good stability in patients with femoral bone transport. The purpose of this study is to investigate the clinical outcomes of bone transport using the Ilizarov technique by rail fixator in the treatment of femoral nonunion or bone defects caused by infection.MethodsClinical feature and treatment outcomes of 32 consecutive adult patients with femoral nonunion or bone defect caused by infection from January 2012 to January 2019 at a minimum of 2 years of follow-ups were retrospectively analyzed. Data were collected on participants' demographic details. All difficulties related to bone transport were documented according to Paley's classification. The clinical outcomes were evaluated using ASAMI criteria at the last clinical visit.ResultsAll 32 patients with an average follow-up of 33.5 months. There were 17 problems, 21 obstacles, and 8 complications, and the complication rate per patient was 1.4. The main complications were pin-site infection (53.1%), axial deviation (21.9%), joint stiffness (18.8%), the delayed union of the docking site (18.8%), soft tissue incarceration(15.6%), delayed consolidation(6.3%), malunion(6.3%), and refracture (3.1%). All the patients achieved bone union, and no recurrence of infection was observed. The excellent and good rates of ASAMI bone and functional results were 87.5% and 81.3%, respectively.ConclusionBone transport using the Ilizarov technique is an effective method for the treatment of femoral nonunion or bone defect caused by infection, and rail fixators have obtained satisfactory results in terms of bone and functional results.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

et al. 2023

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“…Detailed search terms are provided in Additional file 1 . The evaluation of the quality of the studies was conducted through a modified version of the Newcastle–Ottawa scale, which was applied to the studies that were included in the analysis [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Ilizarov technique in the treatment of bone defects of the radius and ulna: a systematic review and meta-analysis

Hamiti,

Yalikun,

et al. 2023

J Orthop Surg Res

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Purpose The objective of this systematic review and meta-analysis was to assess the efficacy of the Ilizarov method in the treatment of radius and ulna bone defects. Methods The PubMed, Embase, Web of Science, Cochrane Library, Ovid MEDLINE, and Scopus databases were searched for articles published up to May 2023. The quality of the studies was evaluated using a modified version of the Newcastle–Ottawa scale. The effect size and confidence intervals at 95% for the main results were calculated. The heterogeneity was evaluated. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), and complications were extracted and analyzed using the Stata version 16. Results This meta-analysis identified and included seven studies involving 98 patients. The union rate of 100% was reported in all studies. According to the findings of the single-arm meta-analysis, the pooled DS was 3.42 cm (95% CI [2.64, 4.21], I2 = 53.5%, P = 0.045), EFT was 148.43 days (95% CI [97.49, 199.38], I2 = 91.9%, P = 0.000), and EFI was 41.32 days/cm (95% CI [35.72, 46.91], I2 = 62.2%, P = 0.021). Pin tract infection was the most common complication, as reported in six studies. Conclusion The findings of the present meta-analysis indicate that the Ilizarov technique is a successful treatment option for bone defects in the radius and ulna. This method has demonstrated efficacy in achieving expected clinical outcomes.

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“…An internationally accepted definition of FRI has been recently adapted [19,20], including 2 levels of certainty around diagnostic criteria: confirmatory (infection is definitely present) and suggestive (further investigation is required to exclude the possibility of an FRI) as previously described. Except for proper antibiotic treatment, the key aspects of surgical management are a thorough debridement, irrigation, fracture stability (usually with Ilizarov frames), dead space management, and adequate soft tissue coverage, but these approaches are usually compromised by the poor soft tissue status, active draining sinuses, osteomyelitis, osteopenia, LLD, and stiffness and contractures of the adjacent joints [25][26][27][28][29].…”

Section: Expected Findingsmentioning

confidence: 99%

Treatment of Infected Tibial Metaphyseal Nonunions Using the Ilizarov Method: Protocol for a Prospective Nonrandomized Study

Sidiropoulos¹,

Panagopoulos²,

Assimakopoulos³

et al. 2022

JMIR Res Protoc

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Background The management of infected metaphyseal nonunion of the tibia is devastating, especially when associated with significant bone loss, poor soft tissues, draining sinuses, axial deformity, knee or ankle joint stiffness, limb discrepancy, and multiresisted pathogens. A systematic review, performed recently by the primary investigators but not yet published, yielded the lack of studies in the field and the huge heterogeneity of the presented results. We found several bias and controversies such as no clear definition of the exact part of the tibia where the nonunion was located, the pathogen causing the fracture-related infection, the number of previous interventions and time to presentation, and the exact type of treatment methods including the use of muscle flaps or bone grafting. Time to final union as a functional score is another important but missing data. Objective The proposed study is designed to evaluate a sufficient number of patients with infected metaphyseal tibial nonunions using various general health, functional, and bone scores. Methods This prospective clinical trial study, with a minimum follow-up period of 36 months, focuses on the effectiveness of the Ilizarov method after radical nonunion debridement and targeted antibiotic therapy in patients with infected metaphyseal tibial nonunions. The primary outcomes would be the definite healing of nonunion and infection-free results. Secondary outcomes would be limb alignment and discrepancy, alteration in the patient’s quality of life, and functional results. A power analysis calculated a minimum of 11 patients to obtain statistical power, but we aim to include at least 25 patients. Limb discrepancy, clinical validation of infection eradication and fracture healing, radiographic validation, and patient-reported outcome measures will be highlighted and correlated. Statistical analysis of the results will offer data missing from the literature so far. Measurements are scheduled at specific times for each patient: preoperatively, 3 and 6 months postoperatively, 1 month after Ilizarov frame removal, and once per semester afterward until the end of the follow-up period (minimum 36 months). Laboratory evaluation will be assessed once per month. Any complication will be reported and treated when it occurs. Results The trial has already started. It was funded in June 2020. As of May 2022, 19 participants have been recruited and no major complications have been noticed yet. Data analysis will be performed after data collection ends, and results will be published afterward. Conclusions An infected metaphyseal tibial nonunion is a rare condition with limited treatment options and many controversies. There is no consensus in the literature about the best treatment strategy, and this lack of evidence should be fulfilled. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 30905788; https://www.isrctn.com/ISRCTN30905788 International Registered Report Identifier (IRRID) DERR1-10.2196/39319

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A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia

Cited by 9 publications

References 27 publications

Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

Clinical outcomes of bone transport using rail fixator in the treatment of femoral nonunion or bone defect caused by infection

Ilizarov technique in the treatment of bone defects of the radius and ulna: a systematic review and meta-analysis

Treatment of Infected Tibial Metaphyseal Nonunions Using the Ilizarov Method: Protocol for a Prospective Nonrandomized Study

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