Reconstruction of large diaphyseal bone defect by simplified bone transport over nail technique: A 7-case series

Ferchaud, François; Rony, Louis; Ducellier, Florian; Cronier, P.; Steiger, Vincent; Hubert, Laurent

doi:10.1016/j.otsr.2017.05.016

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…A subgroup of six studies 45 , 46 , 50 , 51 , 53 , 54 , 57 focusing on the bone transport approach showed a primary union rate of 89.7% with a mean external fixator time of 6.6 months (range 4.2–9.3 months), a complication rate of 66.9%, a reintervention rate of 29.8% and a failure rate of 3.7%.…”

Section: Resultsmentioning

confidence: 99%

“…The average bone defect was 8.8 cm (range 2.7–28 cm), and the average follow-up was 35.7 months (range 6–168 months). The Ilizarov method with external fixation was used in 15 studies 35 , 36 , 46 – 50 , 52 , 56 , 59 – 62 , 65 , intramedullary nailing and/or external fixation was used in eight studies 43 , 45 , 51 , 53 – 55 , 57 , 64 , a monolateral external fixation was used in one study 44 , and bone transport with a five-ring circular external fixator in one study 58 . One of the studies in the Ilizarov group was a case–control comparing bifocal versus trifocal fibular transfer, showing better primary union rate, fewer complications and reinterventions in the trifocal group.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

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To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

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show abstract

“…Systematic review by McMahon et al suggested that circular external fixation provides the most satisfactory results, with IM nailing, and open reduction internal fixation having higher rates of infection [ 6 ]. The use of ex-fix and bone lengthening with IM nail can have up to 50% complication rate including non-unions [ 7 , 8 ]. It is not only our experience but also the literature which demonstrates the use of Ilizarov as a “rescue procedure” in the treatment of tibial fractures when other techniques have failed [ 9 , 10 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Cambridge Protocol for Management of Segmental Bone Loss

Tennyson

Krzak

Krkovič

et al. 2021

JOCR

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Introduction: Segmental long bone defects are some of the most challenging to surgically reconstruct; however, there is no clear guidance on which of the myriad of techniques is superior in a given clinical context. We describe three cases of segmental bone loss presenting to a major trauma center and have use these to develop a treatment algorithm for the sub-acute management of such fractures. Case Report: Case 1 – Acute shortening and delayed lengthening using lengthening intramedullary (IM) nail to treat diaphyseal non-union of the femur with associated 3 cm shortening. Case 2 – 15 cm traumatic bone loss of femur, failed Masquelet, treated with IM nail, monolateral external-fixation and cable with a mean lengthening rate of 46 days/cm. Case 3 – 12 cm tibial traumatic bone loss, failed Masquelet, treated with fine wire frame with a mean lengthening rate of 49 days/cm. Conclusion: As our cases illustrate; attempting complicated, definitive management in the acute phase generates complications and necessitates re-intervention. As such, we have developed a treatment algorithm for traumatic segmental bone loss. We recommend waiting 6 weeks and reimaging to check for evidence of spontaneous bone formation before deciding on definitive treatment. First-line treatment for femoral defects <4 cm is acute limb shortening with delayed lengthening using lengthening IM nail. First-line treatment for femoral defects >4 cm is lengthening over nail with monolateral external fixator. First-line treatment of tibial segmental bone defects in our hands is fine wire circular frames which provide excellent scope for soft tissue coverage and deformity correction. Treatment times of over 2 years in a frame are not uncommon and patients must diligently comply with pin sites management and lengthening protocols. This is the first paper providing an algorithm to guide surgeons in choosing the best lower limb reconstruction options in the sub-acute setting; considering the skill s

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“…Therefore, amputation, extremity disarticulation, and limb salvage procedures have all been utilized historically, with limb salvage techniques becoming increasingly prominent to maintain limb function and anatomy. Limb salvage becomes difficult as the tumor size and subsequent skeletal defect increases, thus necessitating allograft, autograft, or bone transport biologic means of skeletal reconstruction (Ferchaud et al, ; Yang et al, ). Although initially less morbid, allograft does not fully vascularize, resulting in a higher rate of nonunion, fractures, infection, and potentially further surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have showed the efficacy of bone transport methods to reconstruct large segmental defects in trauma, infection, and tumor, although there are limitations, including pin‐site infections, frequent office visits, and multiple procedures (Ferchaud et al, ; Yang et al, ). Further limitations of this technique in tumor cases are related to the effects of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral rotational double‐barrel fibula autograft for limb salvage in a pediatric patient with lower extremity intramedullary osteosarcoma: A case report

et al. 2019

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Osteosarcoma is a relatively uncommon diagnosis that often requires limb salvage techniques in young patients. Due to the potential long‐life expectancy of these patients, techniques which avoid prostheses are preferred to limit the need for future revision surgeries. This case report presents a 9‐year‐old male diagnosed with intramedullary well‐differentiated osteosarcoma of the tibial diaphysis. This limb salvage procedure utilized a rotational ipsilateral vascularized double barrel fibula autograft measuring a total of 24.5 cm when harvested but osteotomized to lengths of 11 and 12.5 cm limbs to reconstruct an 11 cm tibial shaft defect. Anterior chamfer cuts were performed on one limb allowing it to be inserted intramedullary while the second limb was then placed with an inlay technique posterolaterally and then compressed with a carbon fiber plate. The patient recovered well initially postoperatively but was taken back for revision of the carbon fiber plate 10 weeks postoperatively secondary to asymptomatic loosening of the proximal screws. The patient subsequently healed and experienced full graft incorporation with expected hypertrophy of the graft. At most recent follow‐up at 19 months, the patient reported no pain and was utilizing the extremity in a normal fashion with no activity limitations. In this report, we present a case of the use of an ipsilateral rotational double‐barrel fibula autograft for limb salvage in a pediatric patient with lower extremity intramedullary osteosarcoma.

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Reconstruction of large diaphyseal bone defect by simplified bone transport over nail technique: A 7-case series

Abstract: Four-case series.

Cited by 17 publications

References 15 publications

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Cambridge Protocol for Management of Segmental Bone Loss

Ipsilateral rotational double‐barrel fibula autograft for limb salvage in a pediatric patient with lower extremity intramedullary osteosarcoma: A case report

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