Clinical strategies at the docking site of distraction osteogenesis: Are open procedures superior to the simple compression of Ilizarov?

Histological study of the docking site after bone transport. Temporal evolution in a sheep model

“…This paper confirms that consolidation of the docking site occurs despite the connective cap and agrees with authors who defend closed techniques in order to enhance the consolidation of the docking site [8,9,33].…”

Histological study of the docking site after bone transport. Temporal evolution in a sheep model

“…This paper confirms that consolidation of the docking site occurs despite the connective cap and agrees with authors who defend closed techniques in order to enhance the consolidation of the docking site [8,9,33].…”

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

“…It has been suggested that the routine freshening and bone grafting of docking sites should be performed [28][29][30]. However, in our series and others, this would result in the overtreatment of one third of cases.…”

Docking site interventions following bone transport using external fixation: a systematic review of the literature

“…This result was statistically significant (chi-squared p < 0.0001). Included within these failures at the docking site were 7 refractures in the planned intervention group [ 12 , 28 , 32 , 33 ] compared with 21 in the observation group [ 23 , 24 , 27 , 32 – 34 , 41 ] (not significant, p = 0.28). For those studies reporting the outcome, more surgical procedures overall (including planned and unplanned) were required to achieve union in the planned intervention group than the observation group (mean 3.8 in 160 patients from four studies vs. mean 2.2 in 333 patients from 10 studies).…”

“… 0 Nil 14 100% Sala et al [ 25 ] 2013 Endoscopic docking site ( n = 9), open grafting docking site ( n = 18) 27 9.3 cm Some Minimally invasive freshening of bone ends & bone graft ( n = 9), open debridement of bone ends and bone graft ( n = 18) 133 days Endoscopic—EF time 464 days, HI 52.9 days/cm Open—EF time 461 days, HI 48.3 days/cm 26 96% Infected docking site in endoscopic group ( n = 1) 0 Application of new frame & grafting at docking site ( n = 1) 27 100% Hatzokos et al [ 32 ] 2011 Debridement and bone graft ( n = 22), with additional DBM and BMAC ( n = 10) 32 9.3 cm Yes Debridement and application of bone graft prior to docking ( n = 22), with additional application of DBM and autologous bone marrow aspirate ( n = 10) 222 days, 177 days in BMAC/DBM group 27 84% Docking site fracture ( n = 1), non-union ( n = 5) 1 Bone graft to docking site ( n = 5) 32 100% Lovisetti and Sala [ 27 ] 2012 Group B—docking site procedure included a routine “refreshing” of the bone ends ( n = 18) 18 9.4 cm No Debridement and refreshening of bone ends ( n = 18) EF time 455.6 days, HI 52.6 days/cm 18 100% 0 18 100% Spiegl et al [ 26 ] 2013 Bifocal 25 5.7 cm Yes Exploration, debridement of bone ends, autologous bone graft (25), internal fixation or malalignment (4) …”

“…The heterogenous nature of the studies and problems with reporting made it difficult to draw conclusions regarding what type of docking procedure is most effective. All studies in the planned procedure group included refreshing the bone ends in their operative protocol for the docking site intervention, though some undertook this using minimally invasive techniques [ 25 , 27 ]. Many used autologous bone graft, though this was used selectively within studies, making any attempt to understand the effectiveness of this intervention compared to others prone to selection bias.…”

Histological study of the docking site after bone transport. Temporal evolution in a sheep model

“…This paper confirms that consolidation of the docking site occurs despite the connective cap and agrees with authors who defend closed techniques in order to enhance the consolidation of the docking site [8,9,33].…”

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

“…It has been suggested that the routine freshening and bone grafting of docking sites should be performed [28][29][30]. However, in our series and others, this would result in the overtreatment of one third of cases.…”

Docking site interventions following bone transport using external fixation: a systematic review of the literature

“…This result was statistically significant (chi-squared p < 0.0001). Included within these failures at the docking site were 7 refractures in the planned intervention group [ 12 , 28 , 32 , 33 ] compared with 21 in the observation group [ 23 , 24 , 27 , 32 – 34 , 41 ] (not significant, p = 0.28). For those studies reporting the outcome, more surgical procedures overall (including planned and unplanned) were required to achieve union in the planned intervention group than the observation group (mean 3.8 in 160 patients from four studies vs. mean 2.2 in 333 patients from 10 studies).…”

“… 0 Nil 14 100% Sala et al [ 25 ] 2013 Endoscopic docking site ( n = 9), open grafting docking site ( n = 18) 27 9.3 cm Some Minimally invasive freshening of bone ends & bone graft ( n = 9), open debridement of bone ends and bone graft ( n = 18) 133 days Endoscopic—EF time 464 days, HI 52.9 days/cm Open—EF time 461 days, HI 48.3 days/cm 26 96% Infected docking site in endoscopic group ( n = 1) 0 Application of new frame & grafting at docking site ( n = 1) 27 100% Hatzokos et al [ 32 ] 2011 Debridement and bone graft ( n = 22), with additional DBM and BMAC ( n = 10) 32 9.3 cm Yes Debridement and application of bone graft prior to docking ( n = 22), with additional application of DBM and autologous bone marrow aspirate ( n = 10) 222 days, 177 days in BMAC/DBM group 27 84% Docking site fracture ( n = 1), non-union ( n = 5) 1 Bone graft to docking site ( n = 5) 32 100% Lovisetti and Sala [ 27 ] 2012 Group B—docking site procedure included a routine “refreshing” of the bone ends ( n = 18) 18 9.4 cm No Debridement and refreshening of bone ends ( n = 18) EF time 455.6 days, HI 52.6 days/cm 18 100% 0 18 100% Spiegl et al [ 26 ] 2013 Bifocal 25 5.7 cm Yes Exploration, debridement of bone ends, autologous bone graft (25), internal fixation or malalignment (4) …”

“…The heterogenous nature of the studies and problems with reporting made it difficult to draw conclusions regarding what type of docking procedure is most effective. All studies in the planned procedure group included refreshing the bone ends in their operative protocol for the docking site intervention, though some undertook this using minimally invasive techniques [ 25 , 27 ]. Many used autologous bone graft, though this was used selectively within studies, making any attempt to understand the effectiveness of this intervention compared to others prone to selection bias.…”

Histological study of the docking site after bone transport. Temporal evolution in a sheep model

“…This paper confirms that consolidation of the docking site occurs despite the connective cap and agrees with authors who defend closed techniques in order to enhance the consolidation of the docking site [8,9,33].…”

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

“…It has been suggested that the routine freshening and bone grafting of docking sites should be performed [28][29][30]. However, in our series and others, this would result in the overtreatment of one third of cases.…”

Docking site interventions following bone transport using external fixation: a systematic review of the literature

“…This result was statistically significant (chi-squared p < 0.0001). Included within these failures at the docking site were 7 refractures in the planned intervention group [ 12 , 28 , 32 , 33 ] compared with 21 in the observation group [ 23 , 24 , 27 , 32 – 34 , 41 ] (not significant, p = 0.28). For those studies reporting the outcome, more surgical procedures overall (including planned and unplanned) were required to achieve union in the planned intervention group than the observation group (mean 3.8 in 160 patients from four studies vs. mean 2.2 in 333 patients from 10 studies).…”

“… 0 Nil 14 100% Sala et al [ 25 ] 2013 Endoscopic docking site ( n = 9), open grafting docking site ( n = 18) 27 9.3 cm Some Minimally invasive freshening of bone ends & bone graft ( n = 9), open debridement of bone ends and bone graft ( n = 18) 133 days Endoscopic—EF time 464 days, HI 52.9 days/cm Open—EF time 461 days, HI 48.3 days/cm 26 96% Infected docking site in endoscopic group ( n = 1) 0 Application of new frame & grafting at docking site ( n = 1) 27 100% Hatzokos et al [ 32 ] 2011 Debridement and bone graft ( n = 22), with additional DBM and BMAC ( n = 10) 32 9.3 cm Yes Debridement and application of bone graft prior to docking ( n = 22), with additional application of DBM and autologous bone marrow aspirate ( n = 10) 222 days, 177 days in BMAC/DBM group 27 84% Docking site fracture ( n = 1), non-union ( n = 5) 1 Bone graft to docking site ( n = 5) 32 100% Lovisetti and Sala [ 27 ] 2012 Group B—docking site procedure included a routine “refreshing” of the bone ends ( n = 18) 18 9.4 cm No Debridement and refreshening of bone ends ( n = 18) EF time 455.6 days, HI 52.6 days/cm 18 100% 0 18 100% Spiegl et al [ 26 ] 2013 Bifocal 25 5.7 cm Yes Exploration, debridement of bone ends, autologous bone graft (25), internal fixation or malalignment (4) …”

“…The heterogenous nature of the studies and problems with reporting made it difficult to draw conclusions regarding what type of docking procedure is most effective. All studies in the planned procedure group included refreshing the bone ends in their operative protocol for the docking site intervention, though some undertook this using minimally invasive techniques [ 25 , 27 ]. Many used autologous bone graft, though this was used selectively within studies, making any attempt to understand the effectiveness of this intervention compared to others prone to selection bias.…”