The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

Abstract

INTRODUCTIONNonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques.MATERIALS AND METHODSA total of 75patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46years.The mean follow-up period was 10years and 11months.The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression.The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay.RESULTS: Bone union was achieved in all of the75evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me=6.00vs.Me=4.00).DISCUSSIONWe observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group.The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union,length of hospital stay,duration of Ilizarov treatment,or ASAMI bone scores.For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression.The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.Level of EvidenceDiagnostic Level IV

Efficacy comparison of vascularized iliac crest bone flap and Ilizarov bone transport in the treatment of traumatic bone defects of the tibia combined with large soft tissue defects

“…It has been reported that the average number of complications per patient range from 0.67 to 2.27. 15 The average number of complications reported by Aktuglu et al 32 was just 0.29 and the reoperation rate was 12.5%. The authors attribute this to the carefully chosen and meticulous follow-up of each patient.…”

“…Currently, there are multiple approaches to repair segmental tibia defects including autogenous or allogeneic bone graft, [4][5][6] nonvascular bula graft, 7,8 vascularized bular or iliac crest bone ap transplantation, [9][10][11][12][13][14] Ilizarov bone transport, [15][16][17][18][19] masquelet technique, [20][21][22][23] and so forth. All of them presented good e cacy in repairing tibial defects.…”

Fibulin2: a negative regulator of BMSC osteogenic differentiation in infected bone fracture healing

“…Theoretically, fractured bone can self-repair and regenerate via intramembranous and endochondral ossification, in which bone tissue is woven and precursor cells differentiate into osteoblasts in a callus 6 . However, in approximately 10% of fractures, union is delayed or unsuccessful due to unstable fixation, blood supply interruptions, or, in most cases, the presence of infection [7][8][9] . There is an urgent medical need to develop new strategies to promote bone healing and prevent delayed union or nonunion.…”