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

Abstract

Background:The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the efficacy and safety between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects. Methods: A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Relative risk (RR) was used for the binary variables and standard mean difference (SMD) for continuous variables. Each variable included its 95% confidence interval (CI).Results: Five studies, including a total of 199 patients, were included in the meta-analysis. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P <0.00001); however, no significance was observed in bone union time (SMD = -0.02, 95% CI: -0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37). Conclusions:AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.

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

“…Pin tract infection, muscle contracture, axial deviation, and soft tissue incarceration were more likely to occur in the intermediate group, and the distal group was at high risk of joint stiffness, delayed union, or nonunion. 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][2][3][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.…”

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

“…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 Free flaps are useful in the donor site with stable dissection and a hidden location. In clinical practice, anterolateral thigh flaps, thoraco-umbilical flaps, and latissimus dorsi flaps are commonly adopted with respective advantages and disadvantages.…”

3D-printed composite scaffold with anti-infection and osteogenesis potential against infected bone defects

“…In clinical practice, infected bone defects usually have a long disease course and poor prognosis, posing considerable challenges to doctors and patients. 1,2 There are two main causes of infected bone defects. One is severe open fractures caused by high-energy injuries, and approximately 5-30% of such injuries will eventually develop into infected bone defects.…”