Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening

Azzam, Wael; El-Sayed, Mohamed

doi:10.1007/s00590-016-1740-8

Cited by 10 publications

(5 citation statements)

References 29 publications

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“…Among them, Ilizarov distraction osteogenesis can simultaneously address the issues of infection, bone and soft tissue defects, and correction of deformities and eventually achieves the fracture healing. It is one of the most effective therapeutic strategies for posttraumatic complex nonunion [ 5 , 9 , 10 ].Clinically, the Ilizarov circular frame, the Taylor spatial frame (TSF), the semicircular Ilizarov pin fixator, and the conventional external fixation are applied to distraction osteogenesis [ 11 – 15 ]. However, complications associated with external fixation systems are high.…”

Section: Introductionmentioning

confidence: 99%

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Zhang

et al. 2017

J Orthop Surg Res

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BackgroundCurrently, the common treatment for femoral nonunion with large segmental bone defect is difficult and complex. The effective surgical methods are rare, include vascularized bone grafting, Masquelet technique and Ilizarov distraction osteogenesis. The objective of this study is to investigate the outcomes of segmental femoral defects treated with monolateral external fixation using the distraction osteogenesis.MethodsWe retrospectively analyzed patients with femoral nonunion with segmental bone defects (> 6 cm) between January 2010 and January 2014 in our single trauma center. All patients were treated by distraction osteogenesis with monolateral external fixation. All surgeries were performed by the same surgeon. Bone union, duration of distraction osteogenesis in days, time to consolidation in months, external fixation index (EFI), complications, and additional surgical interventions were recorded postoperatively. The modified Application of Methods of Illizarov (ASAMI) criteria were used to evaluate the operative effectiveness.ResultsForty-one patients were enrolled in this study for analysis. The length of the bone defect ranged from 6 to 17 cm. All patients eventually achieved healing, and no patient experienced recurrence of infection or newly developed infection. The average time needed for healing was 13 months. In terms of the incidence of complications, 3 cases axial deviations, 5 cases docking site nonunion, 23 cases pin-tract infection, 14 cases knee joint stiffness or their joint mobility declined, 2 cases osteogenesis insufficient in the distraction area,1 case refracture, and 2 cases loose external fixation pins. In terms of the evaluations of fracture healing and function, 30 patients excellent, 6 patients good, 5 patients fair, and 0 patient poor. In terms of postoperative function evaluations, 21 patients excellent, 9 patients good, 7 patients fair, and 4 patients poor.ConclusionFor patients with femoral nonunion with large segmental bone defects, the monolateral external fixation can provide effective stability, improve compliance, and reduce complications.Electronic supplementary materialThe online version of this article (10.1186/s13018-017-0684-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Zhang

et al. 2017

J Orthop Surg Res

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“…This is in accordance with the results of previous studies. 18,19 The treatment of infected nonunion of long bones is still one of the most challenging problems in orthopedic clinics. However, it is apparent from our patient series that Ilizarov bone transport is an effective method for the treatment of infected nonunion of long bones.…”

Section: Discussionmentioning

confidence: 99%

Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study

et al. 2021

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Objective To examine the efficacy and safety of Ilizarov bone transport in the treatment of infected nonunion of long bones. Methods Patients who underwent Ilizarov bone transport for treatment of bone nonunion with chronic osteomyelitis in the three largest regional orthopedic trauma centers in China from July 2013 to July 2018 were retrospectively examined. Treatment results were evaluated with Paley’s criteria for bone healing and functional assessment. Results In total, 189 patients were treated during the study period. The study population comprised 135 male and 54 female patients with an average age of 37.5 years (range, 11–61 years). The patients were followed up for at least 24 months. According to Paley’s criteria for bone healing and functional assessment, the bone healing results were excellent in 115 (61%) patients, good in 31 (16%), fair in 21 (11%), and poor in 22 (12%). The functional evaluation results were excellent in 76 (40%) patients, good in 65 (34%), fair in 22 (11%), poor in 26 (14%). Conclusion Infected nonunion of long bones can be effectively and safely treated with Ilizarov bone transport.

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“…A systematic review analyzed the outcome of revisions with either ERN or ACP for femoral nonunions after failed IMN. The results showed that bone union was seen in 73% (251/343) of patients of 11 inclusive studies with primary revision by ERN at an average of 7 months and 96% (118/122) of patients of 5 inclusive studies with primary revision by ACP at an average of 6 months respectively [ 8 , 19 – 29 ]. Based on reports in the literature [ 9 , 28 , 29 ], failure of ERN has been noted in nonunions with severe comminuted fracture, large segmental defects, and metaphysial-diaphysial nonunions.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with development of re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing

Chen

et al. 2018

J Orthop Surg Res

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BackgroundCurrently, there remains a lack of consensus regarding factors predictive of complication such as re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing (IMN). A better understanding of prognostic factors could potentially reduce the risk of re-nonunion happening and allow patients to maximize their recovery in the most expeditious manner. Our study aims to identify risk factors in the development of re-nonunion after primary revision inclusive of exchanging reamed nailing (ERN) and augmentative compression plating (ACP) with IMN in situ for femoral shaft nonunion subsequent to failed IMN.MethodsA retrospective study was performed for 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, who were made primary revision with either ERN or ACP from June 2007 to June 2015. The following set of variables was selected based on the speculation that they would contribute to the outcome: sex (male or female), age, body mass index(BMI), smoking, alcohol abuse, cause of injury, fracture type, type of IMN (antegrade or retrograde), use of IMN locking screws(dynamic or static), site of nonunion, primary nonunion time, pathological type of nonunion, bone defect (mm), primary revision method (ERN or ACP), and adjuvant autogenous bone grafting (ABG) (yes or no). Univariate analysis and multiple regression were used to identify risk factors in the development of re-nonunion after primary revision with either ERN or ACP for femoral shaft nonunion subsequent to failed IMN. The minimum follow-up time was 1.5 years (standard deviation [SD] = 1.2, range 1.5–8 years).ResultsOf 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, primary revision with ERN was performed in 33 (52.4%) cases and primary revision with ACP was performed in 30 (47.6%) cases. Adjuvant ABG procedure was undertaken in 39 (61.9%) cases during primary revisions. Re-nonunion was diagnosed as in 18 (28.6%) cases after primary revision with either ERN or ACP. There was a significant difference in time to union between patients treated with primary ERN and those with primary ACP (log-rank, p = 0.006). Furthermore, the difference was also statistically significant between patients with adjuvant ABG procedure and those without it (log-rank, p = 0.009). The relative risk factors included smoking, BMI, site of nonunion, bone defect, primary revision method, and adjuvant ABG procedure. However, primary revision method and adjuvant ABG procedure were shown to be two independent risk factors in multiple logistic regression analysis.ConclusionsPatients with excessive tobacco use, BMI ≥ 30 kg/m2, bone defect ≥ 5 mm, primary revision with ERN, and no adjuvant ABG procedure had a higher likelihood of developing re-nonunion. Of these risk factors, primary revision with ERN and no adjuvant ABG procedure were two strongest risk factors.

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Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening

Abstract: Distraction osteogenesis over the preexisting nail can be a good alternative to treat difficult femoral diaphyseal nonunions associated with significant shortening.

Cited by 10 publications

References 29 publications

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation

Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study

Factors associated with development of re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing

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