Bone transport for limb reconstruction following severe tibial fractures

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...

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“…In 6 of the 27 studies, infected and noninfected CSBD were mixed [19, 25, 29–32, 39]. Eighteen studies included only infected tibial CSBD.…”

Section: Resultsmentioning

confidence: 99%

“…In this review, when the mean complication per patient was evaluated, it was found that 1 out of 27 did not have sufficient information [32] (Table 2). Two of the remaining 26 studies classified complications according to the Paley system.…”

Section: Resultsmentioning

confidence: 99%

Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review

2019

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“…In the treatment of long bone pathologies, there are some processes that keep the length of the limb (e.g., bone transport, bone healing, or tissue engineering [ 30 , 38 , 40 ]) during the regeneration process and others that imply its modification (e.g., bone shortening or lengthening [ 41 , 42 ]). The selection of the proper treatment depends on the clinical pathology of the patient.…”

Section: Methodsmentioning

confidence: 99%

Real-Time Wireless Platform for In Vivo Monitoring of Bone Regeneration

Blázquez-Carmona

Sánchez-Raya

Mora‐Macías

et al. 2020

Sensors

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For the monitoring of bone regeneration processes, the instrumentation of the fixation is an increasingly common technique to indirectly measure the evolution of bone formation instead of ex vivo measurements or traditional in vivo techniques, such as X-ray or visual review. A versatile instrumented external fixator capable of adapting to multiple bone regeneration processes was designed, as well as a wireless acquisition system for the data collection. The design and implementation of the overall architecture of such a system is described in this work, including the hardware, firmware, and mechanical components. The measurements are conditioned and subsequently sent to a PC via wireless communication to be in vivo displayed and analyzed using a developed real-time monitoring application. Moreover, a model for the in vivo estimation of the bone callus stiffness from collected data was defined. This model was validated in vitro using elastic springs, reporting promising results with respect to previous equipment, with average errors and uncertainties below 6.7% and 14.04%. The devices were also validated in vivo performing a bone lengthening treatment on a sheep metatarsus. The resulting system allowed the in vivo mechanical characterization of the bone callus during experimentation, providing a low-cost, simple, and highly reliable solution.

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“…High energy accompanied with open injury leads to severe bone and soft tissue contamination which requires thorough debridement [2] , on the contrary, repeated debridement will cause more serious bone loss and defects which result in further complicated situations such as chronic infections, soft tissue defects, joint contractures, and lower limb deformities or discrepancy [3][4][5] . At present, Ilizarov bone transport technique has become the preferred treatment option to simultaneously solve this series of problems [6] .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Infection Recurrence of Posttraumatic Osteomyelitis Treated with Ilizarov Bone Transport Technique—A Retrospective Study of 149 Cases

Yalikun

Yushan

et al. 2020

Preprint

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Background: Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique. Methods: From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique.Results: All included patients were successfully followed up with an average of 37.5 month (18-78 month), among them, 17 patients (11.41%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with sensitive intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that pseudomonas aeruginosa infection, bone exposure, number of previous operations (>3 times), blood transfusion during bone transport surgery, course of osteomyelitis >3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (>3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarove bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively. Conclusion: The number of previous operations (>3 times), bone exposure, and pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarove bone transport technique.

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Bone transport for limb reconstruction following severe tibial fractures

Cited by 23 publications

References 30 publications

Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review

Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review

Real-Time Wireless Platform for In Vivo Monitoring of Bone Regeneration

Risk Factors Associated with Infection Recurrence of Posttraumatic Osteomyelitis Treated with Ilizarov Bone Transport Technique—A Retrospective Study of 149 Cases

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