Bone transport combined with bone graft and internal fixation versus simple bone transport in the treatment of large bone defects of lower limbs after trauma

Huang, Qiang; Xu, Yi Bo; Ren, Cheng; Li, Ming; Zhang, Cheng Cheng; Liu, Lu; Wang, Qian; Lu, Yao; Lin, Hung-Ching; Li, Zhong; Xue, Han Zhong; Kun, Zhang; Ma, Teng

doi:10.1186/s12891-022-05115-0

Cited by 15 publications

(13 citation statements)

References 27 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average bone defect was 8.8 cm (range 2.7–28 cm), and the average follow-up was 35.7 months (range 6–168 months). The Ilizarov method with external fixation was used in 15 studies 35 , 36 , 46 – 50 , 52 , 56 , 59 – 62 , 65 , intramedullary nailing and/or external fixation was used in eight studies 43 , 45 , 51 , 53 – 55 , 57 , 64 , a monolateral external fixation was used in one study 44 , and bone transport with a five-ring circular external fixator in one study 58 . One of the studies in the Ilizarov group was a case–control comparing bifocal versus trifocal fibular transfer, showing better primary union rate, fewer complications and reinterventions in the trifocal group.…”

Section: Resultsmentioning

confidence: 99%

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

View full text Add to dashboard Cite

To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

show abstract

Section: Resultsmentioning

confidence: 99%

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Patients in the iliac bone transplantation group received autologous iliac bone transplantation, whereas patients in the bone transport group received surgical bone transport [ 4 ]. Patients in both groups were treated with broad-spectrum antibiotics within 2 days of surgery to prevent swelling of the limbs.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect

Huang¹,

Zhu²,

Lü³

2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

Objective. To compare the curative effect of iliac bone transplantation with the bone transport in the treatment of femur fracture complicated with a bone defect. Methods. Patients with femur fractures and defects who were admitted to our hospital from January 1, 2020, to January 31, 2022, and met the inclusion criteria were retrospectively selected and allocated into an iliac bone transplantation group or a bone transport group. The treatment effect and quality of life of the two groups were compared. Results. A total of 98 patients who met the inclusion standards were enrolled, including 50 cases in the iliac bone transplantation group and 48 cases in the bone transport group. There were no significant differences in IL-6, IL-8, TNF-α, visual analog scale (VAS) score, or Japanese Orthopedic Association (JOA) score between the two groups on postsurgical day 1 ( p = 0.051 , 0.150, 0.102, 0.564, and 0.826 respectively), but there were significant differences in the above index on postsurgical day 7 (all p < 0.01 ). There were no significant differences in social function, physical function, role function, and cognitive function between the two groups one week after the operation ( p = 0.245 , 0.051, 0.102, and 0.067, respectively), but there were significant differences in the above parameters at one month after operation ( p = 0.001 , 0.005, 0.005, and 0.001, respectively). The total effective rate of the bone transplantation group was significantly better than that of the iliac bone transplantation group ( p = 0.026 ). The number of postoperative complications in the bone removal group was significantly fewer than that of the iliac bone graft group ( p = 0.001 ). Conclusion. Bone transport is effective in treating femur fractures complicated with bone defects, with fewer postoperative complications.

show abstract

“…Docking site nonunion is a common complication in bone transport [ 1 , 5 , 6 , 8 , 9 ]. It often requires additional surgical intervention, such as bone graft with internal fixation and tissue-engineered strategies [ 25 , 26 ]. In our study, there were 4 cases suffering from docking site nonunion in ASR group and 5 cases in ACSBT group.…”

Section: Discussionmentioning

confidence: 99%

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

Huang

et al. 2022

J Orthop Surg Res

Self Cite

View full text Add to dashboard Cite

Background The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma. Methods In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. Results The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p < 0.05). Conclusion Both techniques can be successfully used for the management of large segmental tibial defects after trauma. There was no significant difference in EFI, limb functions and bone defect healing between the two groups. Compared with ASR group, the complication incidence in ACSBT group was lower, especially the infection-related complications. Therefore, for patients with large segmental bone defects caused by infection or osteomyelitis, ACSBT technique could be the first choice.

show abstract

Bone transport combined with bone graft and internal fixation versus simple bone transport in the treatment of large bone defects of lower limbs after trauma

Cited by 15 publications

References 27 publications

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect

Acute shortening and re-lengthening versus antibiotic calcium sulfate-loaded bone transport for the management of large segmental tibial defects after trauma

Contact Info

Product

Resources

About