Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Testa, Gianluca; Vescio, Andrea; Aloj, Domenico; Costa, Danilo Manuel Cerqueira; Papotto, Giacomo; Gurrieri, Luca; Sessa, Giuseppe; Pavone, Vito

doi:10.3390/jcm9051352

Cited by 25 publications

(18 citation statements)

References 41 publications

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“…In our study, the rate of excellent and good bone healing was 77% and the rate of excellent and good functional recovery was 75%; these rates are not as high as those in previous studies. 20 – 22 Testa et al. 20 reported a 96% rate of excellent or good bone healing and an 84% rate of excellent or good functional recovery in their study.…”

Section: Discussionmentioning

confidence: 88%

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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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Section: Discussionmentioning

confidence: 88%

“… 20 – 22 Testa et al. 20 reported a 96% rate of excellent or good bone healing and an 84% rate of excellent or good functional recovery in their study. Liu et al.…”

Section: Discussionmentioning

confidence: 88%

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

et al. 2021

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“…Thus, the chief surgeon should fully understand the anatomical structure of the lower extremities and make a correct approach for the protection of the periosteum at the osteotomy site before the operation to reduce the probability of delayed union. Besides, the method was recommended by scholars that autologous cancellous bone grafting of the docking site at the end of distraction do a favor to avoid the occurrence of delayed union[6, [29][30][31]. In our study, the patients with delayed union managed with additional surgery of bone grafting and walking with the help of a walking aid after removal of the external clamps to achieve dynamization to promote bone healing.…”

Section: Discussionmentioning

confidence: 94%

Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

Liu

Cai

et al. 2021

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Background: This study aimed to evaluate the clinical and functional outcomes of patients with critical femoral and tibial bone defects treated by trifocal bone transport using the Ilizarov method.Methods: In a retrospective comparative study, 39 patients treated for lower limb bone non-union with bone loss measuring between 6 and 14 cm were included. Depending on the location of bone transport, the patients were divided into the femur group (n =18) and tibia groups (n =21). The demographics data, intraoperative records, and postoperative outcomes were documented and compared between the two groups. At the last follow-up, the bone and functional outcomes were evaluated according to the criterion given by the Association for the Study and Application of the Method of the Ilizarov (ASAMI) and postoperative complications evaluated by Paley classification.Results: The average follow-up time was 26.1 months (range 17–34 months) since the unilateral external fixators were removed. The mean size of the bone defect was 8.3 cm in the femur group, and 7.5 cm in the tibia group. All bone defects were reconstructed successfully. The mean time in external fixation in the femur group was 334.4 days, and in the tibia group was 344.6 days. The external fixation index (EFI) measured 55.9 days/cm in the femur group and 65 days/cm in the tibia group. A statistically significant difference of bone grade was found between the two groups (excellent/good/fair/poor, 3/11/3/1 vs 2/13/4/2, P<0.05), as well as the function grade in two groups (excellent/good/fair/poor/failure, 3/14/1/0 vs 4/13/3/1, P<0.05). According to the ASAMI classification, the clinical and functional results in the femur group were better than in the tibia group. The complication rate of the two groups was 94.4% vs 76.2% (femur vs tibia). One femur and five tibias were performed additional surgery because of delayed union and axial deviation. Conclusions: The trifocal bone transport using the unilateral external fixator is a reliable treatment in the management of post-traumatic and post-infection lower limb bone defects (>6cm). In the comparison of the tibia, the trifocal bone transport treatment period of the femur was shorter, the functional recovery was better and the risk of minor complications was higher.

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“…The Ilizarov technique has been used for the management of high-energy complex fractures, bone nonunion, limb shortening, limb deformities, joint contractures, and bone defects over years [15][16][17][18][19]. For bone defects, the Ilizarov segmental bone transport technique can be applied in the reconstruction of any length theoretically with less invasive fashion and more versatility compared to other methods, especially for massive bone defects > 6 cm.…”

Section: Introductionmentioning

confidence: 99%

Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

Liu

Yushan

Liu

et al. 2021

BMC Musculoskelet Disord

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Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

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Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Cited by 25 publications

References 41 publications

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

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

Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

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