Two stage reconstruction versus bone transport in management of resistant infected tibial diaphyseal nonunion with a gap

Sadek, Ahmed Fathy; Laklok, Mohammed A.; Fouly, Ezzat H.; El-Shafie, Mohamed Bahey Eldeen

doi:10.1007/s00402-016-2523-8

Cited by 36 publications

(28 citation statements)

References 13 publications

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“…In our study, the mean external fixation index was 1.43 months/cm, and the complications was 1.9 per patient; this was quite similar with the results by Paley and Maar [ 19 ] ; their study consisted of 19 patients, the result showed 22 minor and 19 major complications, and the complications were 2.2 per patient. Our results showed an obviously higher complication rate when compared with previous literature, [ 4 , 5 , 8 , 9 , 19 ] whereas all of patients in this study suffered tibial infected nonunion, experienced with multiple previous treatment failures, even in the presence of poor soft tissue coverage; this was an obvious difference from aforementioned studies. Pin-track infection was the most frequently observed complication in the course of bone transport in previous reports, [ 4 , 5 , 8 , 9 , 19 ] and this complication was also noted frequently in our study without a negative impact on the final outcome.…”

Section: Discussioncontrasting

confidence: 77%

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

et al. 2017

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The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20–55 years). All patients previously undergone an average of 2.9 operations (range: 1–6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3–12 cm), and all patients were suffering from soft tissue defects (range: 5–17 cm2). The mean external fixator time (EFT) was 48 weeks (range: 30–62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33–62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0–3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

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Section: Discussioncontrasting

confidence: 77%

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

et al. 2017

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“…Currently, Ilizarov reconstructions, the Masquelet technique, vascularised and non-vascularised bone grafts and bone substitutes are the main methods to treat tibia defects [2,8,9,[17][18][19][20][21][22]. However, bone transfer is the preferred technique for the treatment of infected tibial bone defects [1,4,23,24].…”

Section: Discussionmentioning

confidence: 99%

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Wen

Zhu

et al. 2020

BMC Musculoskelet Disord

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Background: The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the safety and efficacy between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects. Methods: A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The modified Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Standard mean difference (SMD) was used for continuous variables and relative risk (RR) for the binary variables. All of the variables included its 95% confidence interval (CI). Results: Five studies, including a total of 199 patients, were included in the study. Statistical significance was observed in the EFI (SMD = 0.

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“…At present, Ilizarov reconstructions, Masquelet technique, vascularised and non-vascularised bone grafts and bone substitutes are the main methods for tibia defects. [2,8,9,[17][18][19][20][21][22] However, bone transfer is the preferred technique for the treatment of infected tibial bone defects. [1,4,23,24] Ilizarov reconstructions techniques includes two main clinical treatment protocols: bone transport (BT) and acute shortening gradual lengthening (ASD).…”

Section: Discussionmentioning

confidence: 99%

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Wen¹,

Zhu²,

Li³

et al. 2019

Preprint

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Background The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the efficacy and safety between bone transport (BT) and acute shortening technique (AST) in the treatment of infected tibial bone defects.Materials and Methods A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, Embase together with China National Knowledge Infrastructure (CNKI), and Wanfang database for articles published as of August 9, 2019. NOS (Newcastle-Ottawa scale) and Cochrane's risk of bias tool were adapted to evaluated the bias and risk of each eligible study. The data of external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan V.5.3 was used to perform relevant statistical analyses. Relative risk (RR) were used for the binary variables and standard mean difference (SMD) for continuous variable. Each variable included its 95% confidence interval (CI).Results 5 studies, including a total of 199 patients, were included in the meta-analysis. Statistical significance was observed in EFI (SMD = 0.63,95% CI:0.25,1.01,P=0.001) and Bone grafting (RR = 0.26,95%CI:0.15,0.46,P<0.00001), however, no significance was observed in bone union time (SMD = -0.02, 95% CI: -0.39, 0.35, P=0.92), bone results (RR = 0.97,95%CI:0.91,1.04,P=0.41),functional results (RR = 0.96,95%CI:0.86,1.08,P=0.50) and complication (RR = 0.76,95%CI:0.41,1.39,P=0.37).Conclusions AST is preferred on the aspect of minimizing treatment period, while BT is superior to AST for reducing bone grafting. Due to the limited number of trials, The meaning of this conclusion should be taken with caution for infected tibial bone defects.

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Two stage reconstruction versus bone transport in management of resistant infected tibial diaphyseal nonunion with a gap

Cited by 36 publications

References 13 publications

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis

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