Matched comparative study of trifocal bone transport versus induced membrane followed by trifocal bone transport in the treatment of segmental tibial defects caused by posttraumatic osteomyelitis

Abstract

Objectives To compare the efficacy and clinical outcomes of trifocal bone transport (TBT) versus induced membrane followed by trifocal bone transport (IM + TBT) in the treatment of tibial defects > 6 cm caused by posttraumatic osteomyelitis. Methods A total of 69 eligible patients with tibial defects > 6 cm who were treated between January 2010 and January 2018 were retrospectively reviewed. Overall, 18 patients treated by IM + TBT and 18 treated by TBT were matched by propensity score analysis. The mean tibial defect after radical debridement was 6.97 ± 0.76 cm (range, 6.0 to 8.9 cm). The measurements, including demographic data, external fixation index (EFI), external fixation time (EFT), duration of docking union, bone and functional outcomes evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification during follow-up were recorded. Results Age, gender, injury mechanism, affected side, defect size, previous operation time, and follow-up time were not significantly different between the two groups (P > 0.05). The mean EFT was 293.8 ± 12.1 days in the TBT group vs. 287.5 ± 15.3 days in the IM + TBT group. The mean EFI was 36.02 ± 2.76 days/cm vs. 34.69 ± 2.83 days/cm, respectively. The mean duration of docking union was 210.7 ± 33.6 days vs. 179.7 ± 22.9 days, respectively. There was no significant difference in postoperative bone and functional results between the two groups. Delayed union or nonunion and soft tissue incarceration were significantly reduced in the IM + TBT group compared to those in the TBT group. Conclusion Both TBT and IM + TBT achieved satisfactory postoperative bone and functional outcomes in patients with segmental tibial defects > 6 cm following posttraumatic osteomyelitis, while IM + TBT had a significantly lower incidence of postoperative complication in delayed union or nonunion and soft tissue incarceration, as well as faster docking union.

Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial

“…23 Several studies have been published demonstrating the combination of bone transport and Masquelet (induced membrane) techniques in management of infected bone defects, thus minimizing the possible complications of the bone transport technique. [12][13][14][15][16] The previously published studies were retrospective studies 12,14 except the studies by Spiegl et al 13 and Khaled et al, 15 which were prospective noncomparative studies and the study by Hamiti et al 16 which was a retrospective comparative study between trifocal bone transport (TBT) and induced membrane followed by trifocal bone transport (IM + TBT). All studies involved only cases of infected tibial nonunion.…”

“…All studies involved only cases of infected tibial nonunion. [12][13][14][15][16] This study is the first prospective, randomized, controlled, comparative study between BTM and BT techniques in cases of infected nonunited femur and tibia fractures.…”

“…Outcomes measured included external fixation time (EFT) (defined as the period from when the frame was applied to when it was removed [in months]), external fixation index (EFI) (recorded by dividing EFT to defect size [in months/ cm]), and docking time (DT) (defined as the time needed for the docking site union after completion of bone transport [in months]). 16,21 Assessment of bone and functional outcomes were performed using the Association for the Study and Application of the Method of Ilizarov score system. 22 Complications that occurred during the treatment period were recorded and graded according to the Paley 23 classification as problems, obstacles, and true complications.…”

“…Several studies have described combining Masquelet and bone transport techniques in infected nonunion, thus minimizing complications associated with bone transport. 12–16 However, outcomes of bone transport through induced membrane are not well-established regarding infection recurrence and docking site nonunion rates, with limited studies comparing bone transport through induced membrane and conventional bone transport in infected nonunited fractures.…”

“…Several studies have described combining Masquelet and bone transport techniques in infected nonunion, thus minimizing complications associated with bone transport. [12][13][14][15][16] However, outcomes of bone transport through induced membrane are not well-established regarding infection recurrence and docking site nonunion rates, with limited studies comparing bone transport through induced membrane and conventional bone transport in infected nonunited fractures. This is the first prospective, randomized, controlled study comparing bone transport through induced membrane (BTM) and conventional bone transport (BT) in management of bone defects in infected nonunited long-bone fractures of lower limbs to assess whether BTM has better outcomes regarding docking site union and infection recurrence compared with BT.…”