Hexapod Stacked Transport for Tibial Infected Nonunions With Bone Loss: Long-Term Functional Outcomes

Napora, Joshua K.; Weinberg, Douglas S.; Eagle, Blake A.; Kaufman, Bram R.; Sontich, John K.

doi:10.1097/bot.0000000000001005

Cited by 23 publications

(19 citation statements)

References 37 publications

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“…Despite advancements in surgical techniques, nonunion remains a serious therapeutic issue [2-7, 9, 10, 12-19], as it often requires comprehensive surgical treatment involving resection of damaged bone and soft tissues, excision of the focus of infection, and secondary elongation and realignment of the affected bone segment following bone transport [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19]. While evaluating treatment outcomes in nonunion of the tibia, the majority of authors focus on whether or not bone union was achieved [30][31][32][33]. However, bone union may be only short term, as some patients develop re-fracture [1,19], which necessitate further treatment and adversely affect long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…None of the studies mentioned above [30][31][32][33] assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.…”

Section: Discussionmentioning

confidence: 99%

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A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

Szelerski¹,

Kozłowska²,

Żarek³

et al. 2020

Arch Orthop Trauma Surg

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Introduction The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. Materials and methods This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008-2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. Results The mean age at the start of treatment was 46.7 years (11-84 years). The mean follow-up period was 7 years (2-12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8-20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. Conclusions All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7-100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

Szelerski¹,

Kozłowska²,

Żarek³

et al. 2020

Arch Orthop Trauma Surg

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“…A number of techniques have been described to manage deficiencies, including the induced membrane technique, 1 vascularized fibula grafting, 2 acute shortening then lengthening, 3 and bone transport utilizing monolateral, 4 , 5 Ilizarov, 6 , 7 or hexapod fixators. 8 …”

Section: Introductionmentioning

confidence: 99%

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

Wright

Bates

Heidari

et al. 2011

Strategies in Trauma and Limb Reconstruction

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Background Variety of techniques for management of segmental femoral bone loss have been described, each with different advantages and challenges during treatment. The development of motorized lengthening nails has provided a potential for all internal bone transport, avoiding some of the difficulties with external fixation in the femur. At present, there is limited published literature on experiences in this technique. Aim The development of this technique aimed to overcome the difficulties previously reported for internal bone transport in the femur, particularly varus deformity and joint stiffness. Technique We describe the technique of double plating with bone transport utilizing a magnetic lengthening nail to manage segmental femoral bone loss. The benefits of the technique are discussed, along with specific challenges and lessons that have been learned through experience of internal bone transport. Conclusion Use of a magnetic lengthening nail and double plating as a method of all internal bone transport provides an option for the management of massive femoral bone loss, while avoiding some of the challenges that have been reported with the existing techniques. Clinical significance This technique provides an additional method in the armamentarium of the trauma or limb reconstruction surgeon treating massive femoral bone loss. How to cite this article Wright J, Bates P, Heidari N, et al. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019;14(2):94–101.

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“…External fixation-based treatment is used extensively for shortening, managing bone loss, and treating limb deformity. 14 – 16 Some studies have investigated the degree of satisfaction of EF treatment, but no previous work has explored patient-reported satisfaction or investigated the nature of the specific problems 17 associated with such treatment and whether patients would have EF treatment again. Complaints related to EF mostly stemmed from the “pain” and “size of EF”; the same was true for those who were satisfied and those dissatisfied patients who did not want EF treatment again.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey

Ugaji

Matsubara

Kato

et al. 2021

Strategies in Trauma and Limb Reconstruction

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A bstract Background This survey aims to assess the satisfaction of patients who have had treatment using external fixation (EF). Materials and methods An original questionnaire and a Short Form 36 (SF-36) were distributed to 121 patients who underwent treatment using EF for deformity correction and lengthening between 2006 and 2016. A multivariate analysis was performed on the factors associated with satisfaction. Results Sixty patients returned a response. The average satisfaction score was 83.6 points. In the 5-point satisfaction survey, 43 of 60 patients (71.7%) responded “very satisfied” or “satisfied” and 27 patients (45.0%) responded “yes” to the question as to whether they would request EF treatment again if presenting with the original preoperative condition. In addition, the subjectively expressed tolerance for having an external fixator device on the limb was 92.1 days on average. A correlation was established with the ISOLS score. Conclusion The top three factors that determined subjective inconvenience with EF are pain, walking, and heaviness. Although EF treatment was stressful, the satisfaction scores were high. Furthermore, the satisfaction with EF treatment was improved by (1) pain control, (2) shortening the EF period, and (3) psychological support. How to cite this article Ugaji S, Matsubara H, Kato S, et al. Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey. Strategies Trauma Limb Reconstr 2021;16(1):27–31.

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Hexapod Stacked Transport for Tibial Infected Nonunions With Bone Loss: Long-Term Functional Outcomes

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 23 publications

References 37 publications

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss

Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey

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