Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe?

Kınık, Hakan; Kalem, Mahmut

doi:10.1016/j.injury.2019.12.025

Cited by 24 publications

(12 citation statements)

References 27 publications

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“…Hakan Kinik et al. reported all 30 patients with infected tibial nonunion achieved union and infection-free after treated with a similar method [ 13 ]. In their study of comparing clinical results of bifocal or trifocal bone transport, Maimaiaili Yushan et al.…”

Section: Discussionmentioning

confidence: 99%

“…As the first and basic stage of treatment process, infection elimination mainly includes segmental bone resection, extensive soft tissue debridement, and postoperative antibiotics application, aiming to remove infected focus radically and provide a satisfying environment for secondary reconstruction. Conventionally the second-stage reconstruction is carried out 6–8 weeks or months later, after the symptoms of infection have completely disappeared and the inflammatory markers have reduced to normal levels [ 6 ], by means of Masquelet technique [ 7 , 8 ], vascularized fibular grafts [ 9 ], cancellous bone grafting [ 10 ] or Ilizarov segmental bone transport [ [11] , [12] , [13] ]. In total, the entire hospital stay for post-traumatic osteomyelitis treatment usually takes several weeks or even months, during which patients have to endure two episodes of invasive operations, regardless of the failure of therapy and sharply increased financial costs.…”

Section: Introductionmentioning

confidence: 99%

“…Although a similar sequential treatment protocol has been introduced in previous studies [ 11 , 13 , 17 , 18 ], unfortunately, the aims of those studies did not focus on assessing this technique. Besides, to our best knowledge, a comparative study to evaluate the difference of radical debridement combined with bone transport at different stages remains lacking in the report.…”

Section: Introductionmentioning

confidence: 99%

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One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Zhou

Ren

Song

et al. 2021

Journal of Orthopaedic Translation

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Background Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection, but a comparative study remains lacking. This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport, for the management of lower limb post-traumatic osteomyelitis. Methods From January 2013 to June 2018, a total of 102 patients with lower limb post-traumatic osteomyelitis met the criteria were included for analysis, in which 70 patients received one-stage debridement, antibiotic-loaded implantation, metaphysis osteotomy and bone transport were named as one-stage group, while 32 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation, second-stage osteotomy and bone transport were devised as two-stage group. The outcomes of hospitalization (hospital stay, costs of treatment, surgical time, antibiotic usage) and follow-up (infection-free, treatment failure, infection recurrence, external fixation index (EFI) and docking site union) between the two groups were retrospectively compared. Results For outcomes of hospitalization, patients in the one-stage group had batter results on hospital stay (18.2 days versus 28.9 days, P < 0.05), surgical time (164.8 min versus 257.4 min, P < 0.05), cost of treatment (¥101726.1 versus ¥126718.8, P < 0.05) and the course of antibiotic usage (10.3 days versus 12.0 days, P < 0.05). During the follow-up, 87.1% (61/70) patients in the one-stage group compared to 93.8% (30/32) patients in the two-stage group achieved infection-free (P > 0.05) without any additional debridement operation. 94.3% (66/70) patients in the one-stage group earned wound healing after the operation, comparing to 96.9% (31/32) patients healed in the two-stage group (P > 0.05). Uncontrolled infection was observed on 4 (5.7%) patients in the one-stage group and 1 (3.1%) patients in the two-stage group (P > 0.05), with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively. 5 (7.2%) patients in the one-stage group and 1 (3.2%) patient in the two-stage group encountered with infection recurrence (P > 0.05) and were well-managed with re-debridement and antibiotics usage. Significance was not found between two groups on EFI (74.8 days/cm versus 69.0 days/cm, P > 0.05) and docking site nonunion rate (14.5% versus 18.9%, P > 0.05), indicating that bone transport in different stages played a less essential role on bone generation process. The other complications, such as prolonged aseptic drainage [24.3% (17/70) versus 21.9% (7/32)], re-fractur...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Zhou

Ren

Song

et al. 2021

Journal of Orthopaedic Translation

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“…6 De acuerdo con nuestros resultados, consideramos que la transportación ósea es una buena alternativa en el manejo de las pérdidas óseas mayores de tibia, por lo que recomendamos su uso en casos de pérdidas importantes. 7 Sin embargo, debe considerarse que durante el seguimiento pueden presentarse algunas complicaciones o dificultades técnicas, por lo que este procedimiento debe realizarse por cirujanos con un entrenamiento adecuado (Figura 6).…”

Section: Discussionunclassified

Recuperación de pérdida ósea en pseudoartrosis infectada de tibia con técnica de transporte óseo de De Bastiani

Paola¹,

Gutiérrez²,

Enrique³

et al. 2021

Ortho-Tips

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El transporte óseo se refiere a la capacidad de llevar hueso sano de un segmento diafisario hacia una zona de defecto óseo por cualquier causa, generando una osteogénesis paulatina y progresiva para cubrir un defecto. Objetivo: Reportar la función de la extremidad pélvica de dos casos de pacientes con pseudoartrosis infectada de tibia tratados con transporte óseo con método de fijador externo tipo monorriel en el Centenario Hospital «Miguel Hidalgo». Material y métodos: Se trata de un estudio retrospectivo, descriptivo y analítico. Se hizo una búsqueda en la base de datos del hospital donde se reportaron dos casos de pacientes con diagnóstico de pseudoartrosis infectada de tibia tratados con transporte óseo. Se recabaron las variables de estudio en una ficha predefinida incluyendo variables sociodemográficas. Resultados: Uno fue hombre y una mujer con edades de 15 y 17 años. Uno de los casos fue por fractura expuesta y una cerrada. La pérdida ósea promedio fue de 10 cm. La fase de reposo fue de 15 días promedio. De acuerdo con los criterios de Paley, los resultados óseos fueron excelentes en un caso y bueno en el otro. En uno de los casos ya se retiró el fijador tipo monorriel y ya tiene consolidación completa. Los reactantes de fase aguda en los dos casos ya se encuentran negativos. Los resultados funcionales son excelentes en un paciente y bueno en el otro. Los dos pacientes cuentan ya con apoyo completo de la extremidad. Conclusión: Los resultados muestran que la transportación ósea mediante la técnica de De Bastiani es una buena alternativa para el manejo de pacientes con pérdida ósea mayor de tibia.

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“…As shown by several comparative studies, these treatment options have their advantages and limitations. However, the Ilizarov bone transport has been the most frequent practice in nonunion and defect management, especially in infected tibia[ 34 , 35 ]. Current clinical investigations focus on the need for complete eradication of infection through radical debridement[ 34 - 39 ].…”

Section: Current Clinical Practice and Research In The Ilizarov Techniques Of Bone Reconstructionmentioning

confidence: 99%

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)

Malkova

Borzunov

2021

WJO

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The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed “limb lengthening and reconstruction surgery”. Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.

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Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe?

Cited by 24 publications

References 27 publications

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Recuperación de pérdida ósea en pseudoartrosis infectada de tibia con técnica de transporte óseo de De Bastiani

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)

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Ilizarov segmental bone transport of infected tibial nonunions requiring extensive debridement with an average distraction length of 9,5 centimetres. Is it safe?

Cited by 24 publications

References 27 publications

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Recuperación de pérdida ósea en pseudoartrosis infectada de tibia con técnica de transporte óseo de De Bastiani

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

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Product

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International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)