Central bone transport system optimizes reconstruction of bone defects

Baumgart, R; Hinterwimmer, Stefan; Kettler, M.; Krammer, M.; Mutschler, Wolf

doi:10.1007/s00113-005-0966-4

Cited by 16 publications

(4 citation statements)

References 18 publications

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“…This did not necessarily correlate with when bone regenerate was considered strong enough for frame removal. Other authors have reported similar results[ 24 ]. We therefore advocate early resection of devitalized bone, as this reduces the risk of infection whilst still achieving good results with long transport distances.…”

Section: Discussionsupporting

confidence: 82%

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Patel¹,

Logan²,

Krkovič³

2021

WJO

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BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies. Our aim was to provide an overview of the largest single-center experience in the literature, with minimum 1-year follow-up, of adult type 3 open tibial shaft fractures at Cambridge University Hospitals (a United Kingdom major trauma center). We sought to define patient characteristics and our main outcome measures were infection, union and re-fracture. AIM To retrospectively define patient and injury characteristics, present our surgical methods and analyze our outcomes–namely infection, union and re-fracture rates. METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020 (26 classified as Gustilo-Anderson 3A, 47 were 3B and two were 3C). Nine patients underwent intramedullary nailing (IMN), 61 underwent Taylor spatial frame (TSF) fixation and 5 were treated with Masquelet technique (IMN and subsequent bone grafting). RESULTS Mean follow-up was 16 mo (IMN) and 25 mo (TSF). We had an infection rate of 6.7% (5), non-union rate of 4% (3) and re-fracture rate of 2.7% (2). Average time to union was 22 wk for IMN and 38.6 wk for TSF. Thirty-three cases had a bone defect with a mean of 5.4 cm (2-11). Patient age, sex, diabetes, smoking status or injury severity did not have a significant effect on union time with either fixation method. Our limb salvage rate was 98.7%. CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN. Grade 3B/C injuries are best treated by circular external fixators as they provide good, reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.

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Section: Discussionsupporting

confidence: 82%

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Patel¹,

Logan²,

Krkovič³

2021

WJO

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“…A study published in 2005 by Baumgart et al similarly noted a higher complication rate (2.3 vs 1.6) and a higher BHI (50.2 vs 40.8) following the development of osteitis. 18 Schmidt et al . (2002) also reported an increased BHI in patients with pre-existing osteitis.…”

Section: Discussionmentioning

confidence: 99%

“…The size of the resulting defect should distinctly be the second priority to minimizing infection risk; as the number of operations, amount of complications, length of hospital stay and BHI are all significantly increased in the case of infection. 18 , 19…”

Section: Discussionmentioning

confidence: 99%

Bone transport for limb reconstruction following severe tibial fractures

et al. 2016

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A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years) and average defect size 6.6 cm (range 3.0 to 13.4 cm). After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered.

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“…In der Fachliteratur finden sich Heilungs-Indices von ca. 26 – 50 Tagen pro cm Defektstrecke 15 , 16 , 17 .…”

Section: Biologische Knochentransplantateunclassified

Knochenaufbau und Knochenersatzmaterialien

Lang¹,

Klute²,

Rupp³

et al. 2022

Orthopädie und Unfallchirurgie up2date

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Knochendefekte können primär aus traumatologischen Ursachen sowie sekundär aus Knocheninfektionen und Tumorerkrankungen resultieren. Die chirurgische Wiederherstellung der Bewegungsorgane bei Vorliegen eines behandlungsbedürftigen Knochendefekts stellt trotz der Entwicklung diverser Verfahren zum Knochenersatz und Knochenaufbau auch heute noch eine Herausforderung dar. Das autologe Knochentransplantat gilt als Goldstandard in der Behandlung. Wachsende Bedeutung wird den synthetischen Knochenersatzmaterialien beigemessen.

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Central bone transport system optimizes reconstruction of bone defects

Abstract: In contrast to conventional methods reduced pin tract infections offer better conditions for internal fixation. Control of length and axis can be optimized, immobilization of the patients is reduced, and the comfort of treatment is significantly improved.

Cited by 16 publications

References 18 publications

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Bone transport for limb reconstruction following severe tibial fractures

Knochenaufbau und Knochenersatzmaterialien

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