Cambridge experience in spontaneous bone regeneration after traumatic segmental bone defect: a case series and review of literature

Abdulkarim, Ali; Hu, Shu Yang; Walker, Brendon; Krkovič, Matija

doi:10.1136/bcr-2019-232482

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…We have presented a case series of patients with severe fractures that have been initially treated with ORIF, prior to bone transport with the monorail external fixator. This was done based on prior evidence that 30.8% of traumatic segmental long bone defects undergoes spontaneous regeneration [ 12 ]. The remaining patients, such as the ones included in this case series, will need definitive bone transport treatment.…”

Section: Discussionmentioning

confidence: 99%

Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

Zhang

Zhou

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail. Methods Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery. Results Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00. Conclusion Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients’ quality of life to a level comparable with the normal population.

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Section: Discussionmentioning

confidence: 99%

Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

Zhang

Zhou

et al. 2021

Eur J Orthop Surg Traumatol

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“…This was followed by AxSOS plate when patient was stable with no sign of infection and fit for surgery. After on average 6 weeks if there was no spontaneous union [ 17 ] we proceeded with PRECICE nail and corticotomy. All the operations were performed with the PABST technique and by the same surgeon.…”

Section: Methodsmentioning

confidence: 99%

“…After the initial treatment, the bone transport surgery is delayed by 6 weeks for any signs of spontaneous bone regeneration [ 17 ]. Although there is no clear guideline on the appropriate length of delay, they are not usually less than 3–4 weeks and Wright et al had allowed for 8–10 weeks to address associated injuries and any active infection [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Bone transport with magnetic intramedullary nails in long bone defects

Summers

Krkovič

2020

Eur J Orthop Surg Traumatol

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Background This study describes the outcomes of internal bone transport with magnetic nails in five cases of traumatic segmental femoral bone defects. Methods Five patients with open fracture of the femur and diaphyseal bone loss were included between May 2018 and August 2020. The mean femoral defect was 8.7 cm (range 5.6–16.0). Intervention We used plate-assisted bone segment transport (PABST) with PRECICE magnetic nails. Results All five patients have fully consolidated. The mean consolidation time and index were 7.5 months and 0.8 mo/cm, respectively. The mean follow-up was 21.3 months. The main complications were reduced knee ROM, mild varus deformity and plate bending. Post-operative SF-36, Oxford Knee scores and ED-5Q-5L scores were also compiled for four of five patients. SF-36 and Oxford Knee scores were reported without pre-injury data for comparison. ED-5Q-5L index and VAS were compared UK population norm and were both found to be statistically insignificant (p = 0.071 and p = 0.068, respectively). Conclusion Bone transport with magnetic nails has the capacity to obtain good functional recovery in long bone defects despite variable outcome pictures. In response to variable outcome reporting in the literature, we propose a standard reporting template for future studies to facilitate more rigorous analyses.

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“…Critical bone defect is commonly defined as a large defect that may not heal spontaneously, which can be caused by severe fracture, infection, tumor resection, chronic nonunion, etc. [1][2][3]. Because of variable anatomical locations and geometries, conditions of periosteum and soft tissue, biomechanical environments, as well as patients' basic conditions, its treatment still remains surgical, socioeconomic and investigative challenges [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Repair of critical diaphyseal defects of lower limbs by 3D printed porous Ti6Al4V scaffolds without additional bone grafting: a prospective clinical study

Liu

Hou

Yang

et al. 2022

J Mater Sci: Mater Med

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The repair of critical diaphyseal defects of lower weight-bearing limbs is an intractable problem in clinical practice. From December 2017, we prospectively applied 3D printed porous Ti6Al4V scaffolds to reconstruct this kind of bone defect. All patients experienced a two-stage surgical process, including thorough debridement and scaffold implantation. With an average follow-up of 23.0 months, ten patients with 11 parts of bone defects were enrolled in this study. The case series included three females and seven males, their defect reasons included seven parts of osteomyelitis and four parts of aseptic nonunion. The bone defects located at femur (five parts) and tibia (six parts), with an average defect distance of 12.2 cm. Serial postoperative radiologic follow-ups displayed a continuous process of new bone growing and remodeling around the scaffold. One patient suffered tibial varus deformity, and he underwent a revision surgery. The other nine patients achieved scaffold stability. No scaffold breakage occurred. In conclusion, the implantation of 3D printed Ti6Al4V scaffold was feasible and effective to reconstruct critical bone defects of lower limbs without additional bone grafting.

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Cambridge experience in spontaneous bone regeneration after traumatic segmental bone defect: a case series and review of literature

Cited by 6 publications

References 37 publications

Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

Bone transport with magnetic intramedullary nails in long bone defects

Repair of critical diaphyseal defects of lower limbs by 3D printed porous Ti6Al4V scaffolds without additional bone grafting: a prospective clinical study

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