Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Wen, Hongjie; Zhu, Shouyan; Li, Canzhang; Xu, Yongqing

doi:10.1186/s12891-020-3114-y

Cited by 17 publications

(10 citation statements)

References 40 publications

(96 reference statements)

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“…It’s generally recognized that the defect and deformity can be resolved simultaneously by the bone transport using an external fixator, allowing the patient to utilize the limb function earlier to prevent joint stiffness or arthritis [ 1 – 4 , 17 ], However, this technique is also a great challenge for surgeons since the long EFT and tricky complications [ 18 , 19 ]. Some interventions have been applied to shorten the EFT, such as fixation combined with an internal and external fixator, cyclic distraction and compression technique at the consolidation stage, or injection of biological agents that promote bone healing in the distraction area, etc.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Peng

Tian³

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to evaluate the outcomes of bifocal bone transport in the treatment of femoral bone defects caused by infections. Methods Clinical and radiographic data of patients with infected femoral nonunion treated by the bifocal bone transport at our hospital were analyzed retrospectively, from January 2008 to December 2019. Depending on the location of bone defects, the patients were divided into three groups (proximal, intermediate, and distal). The Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria was applied to assess the bone and functional outcomes. Postoperative complications of three groups were documented and compared. Results Seventy-six cases of infected femoral bone defects (31 cases of proximal, 19 cases of intermediate, and 26 cases of distal) were managed by bifocal bone transport successfully with a mean follow-up time of 30.8 months (range, 23 to 41 months). There were 58 men (76.3%) and 18 women (23.6%), with a mean age of 38.8 years (range, 23 to 60 years). The bone union was received in 76 cases with a mean of 6.9 months (range, 5 to 8 months). Pin tract infection was observed in twenty-nine cases (38.1%), 7 cases (9.2%) of muscle contractures, 3 cases (7.9%) of joint stiffness, 13 cases (17.1%) of axial deviation, 2 cases (2.6%) of delayed union, one case (1.3%) of nonunion, and none (0%) of transport gap re-fracture. One patient (1.3%) was scheduled for knee arthroplasty when bone transport treatment ended. Conclusions Bone transport using an external rail fixator was a practical method to treat the femoral bone defects, since the satisfactory rate of bone union and limb function recovery. Complications of distal femoral bone transport were more severe than the proximal and intermedia, but the rate of complication was the least of the three groups. Soft-tissue-related complications were more likely to occur in the intermediate bone transport.

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Section: Discussionmentioning

confidence: 99%

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Peng

Tian³

et al. 2022

BMC Musculoskelet Disord

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“…The Ilizarov technique has been successfully used for many years to treat bone defects caused by pathological diseases [ 4 , 6 – 8 , 16 – 18 ]. Bone transport using a unilateral external fixator, based on the Ilizarov technique, has been widely utilized for the treatment of CSBD caused by infection in lower limbs [ 2 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nonunion caused by infection is a common complication after the treatment of the lower extremity open fracture, which needs plenty of medical resources to resolve [ 1 – 6 ]. Particularly, the bone defect caused by infection is one of the challenging musculoskeletal problems in orthopaedic surgery [ 4 , 7 , 8 ]. Based on the Ilizarov technique, bone transport using a unilateral external fixator is a practical method for the management of bone defects in lower limbs.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport

Abula

Cheng

Abulaiti

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to investigate the risk factors of transport gap bending deformity (TGBD) in the treatment of critical-size bone defect (CSBD) after the removal of the external fixator. Methods From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using a unilateral external fixator in our medical institution. TGBD was defined as the bone callus in the distraction area with a deviation to the force line of the femur (> 10°) or tibia (> 12°) after removal of the external fixator. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson’s Chi-square test was analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD. Results A total of 178 patients were enrolled in the study, with a mean follow-up time of 28.6 ± 3.82 months. The positive result of the bacteria isolated test was observed in 144 cases (80.9%). The rate of excellent and good in the bone outcomes (excellent/good/fair/poor/failure, 41/108/15/14/0) was 83.7%, and 92.3% in the functional results (excellent/good/fair/poor/failure, 50/98/16/14/0) according to the ASAMI criteria. TGBD after removal of external fixator occurred in twenty-two patients (12.3%), including 6 tibias, and 16 femurs. Age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, osteoporosis, glucocorticoid intake, duration of infection > 24 months, EFT > 9 months, EFI > 1.8 month/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis (P < 0.05). The incidence more than 50% was found in patients with femoral defect (76.1%), osteoporosis (72.7%), BMI > 25 kg/m2 (69.0%), diabetes (59.5%), glucocorticoid intake (54.7%). In the multivariate logistic regression analyses, the following factors were associated independently with TGBD, including age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, and osteoporosis. Conclusions Bone transport using a unilateral external fixator was a safe and practical method in the treatment of CSBD caused by infection. The top five risk factors of TGBD included femoral defect, BMI > 25 kg/m2, duration of bone infection > 24 months, age > 45 years, and diabetes. Age > 45 years, BMI > 25 kg/m2, femoral defect, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.

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“…Some studies have demonstrated that the “shortening–lengthening technique” shortens the bone healing time and decreases the proportion of bone grafting. 6 , 15 , 16 , 29 …”

Section: Discussionmentioning

confidence: 99%

Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

Zeng

Yuan³

et al. 2021

J Int Med Res

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Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.

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Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Cited by 17 publications

References 40 publications

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Evaluation of complications associated with bifocal bone transport as treatment for either proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients

Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport

Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

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