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Zhang Q, Rehemutula A, Maitudi M, Yang Q, Yalikun A, Zhou H, Si Y, Chen Z, Liu D, Li Q, Liu T, Li L, Yusufu A. Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique. Injury 2025; 56:112224. [PMID: 40020515 DOI: 10.1016/j.injury.2025.112224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 02/16/2025] [Accepted: 02/18/2025] [Indexed: 03/03/2025]
Abstract
INTRODUCTION The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects. METHODS We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score. RESULTS In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; p < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life. CONCLUSION The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.
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Affiliation(s)
- Qiyue Zhang
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aierken Rehemutula
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | | | - Qin Yang
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ainizier Yalikun
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hongyu Zhou
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yu Si
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zihao Chen
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dun Liu
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qian Li
- Department of Pharmacy, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tao Liu
- Department of Geriatrics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Li
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Alibakan G, Kanar M, Armağan R, Sülek Y, Altuntaş Y, Eren OT. Cable-asisted bone transport versus circular external fixators-asisted bone transport in the management of bone defects of the Tibia: clinical and imaging results. J Orthop Surg Res 2025; 20:264. [PMID: 40069761 PMCID: PMC11899003 DOI: 10.1186/s13018-025-05648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
PURPOSE The aim of this study was to compare the efficacy, clinical outcomes, and complications of cable-asisted bone transport (CASt) and circular external fixator-assisted bone transport (CEFt) methods in the management of bone defects of the tibia. METHODS A retrospective analysis was conducted on 32 patients who underwent segmental bone transport for tibial bone defects between January 2006 and January 2020 and met the study inclusion criteria. Patients were categorized into two groups: CASt group (n = 16) and CEFt group (n = 16). The primary outcome measures included radiological parameters (External Fixator Index (EFI), Radiological Consolidation Time (RCT), and Radiological Consolidation Index (RCI)), functional independence (Lower Extremity Functional Index, LEFI) and functional outcomes (ASAMI Bone and Functional Scores). Secondary outcomes included pain levels (Visual Analog Scale, VAS), and complication rates (Paley's and Checketts-Otterburn classifications). RESULTS The CASt method resulted in significantly reduced pain scores during distraction (VAS: 4.81 ± 0.98 vs. 6.75 ± 0.86; p = 0.001). Pin-tract infection rates were significantly lower in the CASt group compared to the CEFt group (50% vs. 93.8%; p = 0.013). There was no significant difference between the groups in radiological (EFI, RCT, RCI) and functional outcomes (ASAMI scores) (p > 0.05). CONCLUSION Both CASt and CEFt methods are effective and reliable options in the management of bone defects of the tibia. However, CASt offers advantages such as lower pin-tract infection rates and less pain during distraction, resulting in greater patient comfort and compliance. Given its less invasive nature, CASt may be preferable in patients at higher risk of infection or with a low pain threshold. However, the technical complexity of this method requires experienced surgical application.
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Affiliation(s)
- Güngör Alibakan
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
| | - Muharrem Kanar
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Raffi Armağan
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Sülek
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Altuntaş
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Osman Tuğrul Eren
- Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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Saleh AK, Yusof NM, Attallah AA, Elshal EA, Khames AAA, Ibrahim MNA, Mahmoud MMM, Abdeltawab GE, Abuomira IEAA. Ilizarov External Fixator Versus Orthofix LRS in Management of Femoral Osteomyelitis: A Propensity Score Matched Analysis. Indian J Orthop 2024; 58:1272-1277. [PMID: 39170658 PMCID: PMC11333652 DOI: 10.1007/s43465-024-01208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/18/2024] [Indexed: 08/23/2024]
Abstract
Purpose Treatment of osteomyelitis (OM) is challenging. Ilizarov bone transport is a commonly used technique for management of OM. The recently introduced limb reconstruction system (LRS) has been effectively used for management of OM. It was suggested to be easier in use and less invasive. The present retrospective study aimed to compare LRS and Ilizarov bone transport in management of femoral OM using a propensity score matched analysis. Methods The present retrospective study included 80 consecutive patients with femoral OM. The studied patients were managed either using Ilizarov external fixator (n = 40) or Orthofix LRS (n = 40). The clinical outcome measurements included union time, limb length discrepancy, additional operative procedures, refracture and infection. Results Patients in the LRS group were exposed to significantly higher frequency of bone transport (30.0 versus 15.0%) and lower frequency of acute compression and lengthening (10.0 versus 32.5%). Patients in Ilizarov group had significantly higher frequency of tobramycin pellets as compared to their counterparts. The studied groups were comparable regarding the operative complications including pin-tract infection, non-union at docking site and refracture. Patients in the Ilizarov had significantly shorter time to union (8.2 ± 3.2 versus 11.0 ± 5.6 months, p = 0.012). No statistically significant differences were found between the studied groups regarding the quality-of-life domains. Conclusions Use of Ilizarov external fixator and Orthofix LRS devices proved to be effective and reliable. Their influences on patients' quality appear to be comparable.
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Affiliation(s)
- Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Nazri Mohd Yusof
- Advanced Trauma and Limb Reconstructive Surgery, Kuliyyah of Medicine, International Islamic University of Malaysia, Kuala Lumpur, Malaysia
| | - Abdehamid A. Attallah
- Department of Orthopedic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ehab Abdelftah Elshal
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | | | | | - Gaber Eid Abdeltawab
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Yang J, Wang Z, Jiang L, Tang L, Li Z, Liu Y. Nomogram construction and validation of axial deviation in patients with tibial defects treated with the Ilizarov bone transport technique. BMC Musculoskelet Disord 2024; 25:483. [PMID: 38898453 PMCID: PMC11186107 DOI: 10.1186/s12891-024-07603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The Ilizarov bone transport technique is widely recognised as an effective method for treating large segment bone defects in clinical practice. However, axial deviation is a common complication in the treatment of tibial large segment bone defects, which can have a serious impact on the clinical efficacy of bone transport. Our study aims to construct and validate a nomogram for predicting axial deviation of tibial bone transport. METHOD This study retrospectively collected data from 363 patients who underwent the tibial Ilizarov technique for bone transport. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for axial deviation, which were later used to construct a nomogram. The nomogram was evaluated using the decision curve analysis (DCA), the calibration curve, and the area under the receiver operating characteristic curve (AUC). RESULTS Of the 363 patients who underwent Ilizarov tibial bone transport, 31.7% (115/363) experienced axial deviation. Multivariate logistic regression analysis showed that gender, height, defect site, and external fixation index were important risk factors for axial deviation. The AUC value of the nomogram model was 0.705. The calibration curve and the decision curve analysis showed a good consistency between the actual axial deviation and the predicted probability. CONCLUSION The model assigns a quantitative risk score to each variable, which can be used to predict the risk of axial deviation during tibial bone transport.
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Affiliation(s)
- Jinghong Yang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Lu Zhou, 646000, People's Republic of China
- Stem Cell Immunity and Regeneration Key Laboratory of Luzhou, Lu Zhou, 646000, People's Republic of China
| | - Zi Wang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Lu Zhou, 646000, People's Republic of China
- Stem Cell Immunity and Regeneration Key Laboratory of Luzhou, Lu Zhou, 646000, People's Republic of China
| | - Lujun Jiang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Lu Zhou, 646000, People's Republic of China
- Stem Cell Immunity and Regeneration Key Laboratory of Luzhou, Lu Zhou, 646000, People's Republic of China
| | - Lian Tang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China
| | - Zhong Li
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Lu Zhou, 646000, People's Republic of China.
- Stem Cell Immunity and Regeneration Key Laboratory of Luzhou, Lu Zhou, 646000, People's Republic of China.
| | - Yanshi Liu
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Lu Zhou, 646000, People's Republic of China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Lu Zhou, 646000, People's Republic of China.
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Ren Z, Cai W, Lu Y, Lu Y, Wu H, Cheng P, Xu Z, Han P. Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis. J Bone Joint Surg Am 2023; 105:1527-1536. [PMID: 37603599 DOI: 10.2106/jbjs.23.00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Osteomyelitis causes marked disability and is one of the most challenging diseases for orthopaedists to treat because of the considerable rate of infection recurrence. In this study, we proposed and assessed the debridement-reconstruction-docking (DRD) system for the treatment of lower-extremity osteomyelitis. This procedure comprises 3 surgical stages and 2 preoperative assessments; namely, pre-debridement assessment, debridement, pre-reconstruction assessment, reconstruction, and docking-site management. We evaluated the use of the DRD system compared with the Ilizarov technique, which is defined as a 1-stage debridement, osteotomy, and bone transport. METHODS This retrospective cohort included 289 patients who underwent either DRD or the Ilizarov technique for the treatment of lower-extremity osteomyelitis at a single institution between January 2013 and February 2021 and who met the eligibility criteria. The primary outcome was the rate of infection recurrence. Secondary outcomes included the external fixator index (EFI), refracture rate, and the Paley classification for osseous and functional results. An inverse-probability-weighted regression adjustment model was utilized to estimate the effect of the DRD system and Ilizarov technique on the treatment of lower-extremity osteomyelitis. RESULTS A total of 131 and 158 patients underwent DRD or the Ilizarov technique, respectively. The inverse-probability-weighted regression adjustment model suggested that DRD was associated with a significant reduction in infection recurrence (risk ratio [RR], 0.26; 95% confidence interval [CI], 0.13 to 0.50; p < 0.001) and EFI (-6.9 days/cm, 95% CI; -8.3 to -5.5; p < 0.001). Patients in the DRD group had better Paley functional results than those in the Ilizarov group (ridit score, 0.55 versus 0.45; p < 0.001). There was no significant difference between the 2 groups in the rate of refracture (RR, 0.87; 95% CI, 0.42 to 1.79; p = 0.71) and Paley osseous results (ridit score, 0.51 versus 0.49; p = 0.39). CONCLUSIONS In this balanced retrospective cohort of patients with lower-extremity osteomyelitis, the use of the DRD system was associated with a reduced rate of infection recurrence, a lower EFI, and better Paley functional results compared with the use of the Ilizarov technique. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Zun Ren
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Jiang G, Li J, Zhang X, Shu S, Ma Y, Zhang P, Wang G, Liao H, Hu J. Limb Reconstruction System Assisted Reduction and Internal Fixation for Intra-Articular Calcaneal Fractures: A New Application. Orthop Surg 2023; 15:2540-2548. [PMID: 37526145 PMCID: PMC10549802 DOI: 10.1111/os.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Minimally invasive reduction and fixation of intra-articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra-articular calcaneal fractures, and propose the indications of our protocol. METHODS In this retrospective study, a series of 34 consecutive closed and displaced intra-articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X-ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed-rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired-Samples t-test. RESULTS Thirty-two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow-up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor. CONCLUSIONS For intra-articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub-talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.
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Affiliation(s)
- Guiyong Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jie Li
- Department of OrthopaedicsSouthern Medical University Zengcheng Branch of Nanfang HospitalGuangzhouPeople's Republic of China
| | - Xiaolong Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Shan Shu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yunfei Ma
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Gang Wang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Hua Liao
- Department of Human Anatomy, School of Basic Medical SciencesSouthern Medical UniversityGuangzhouChina
| | - Jijie Hu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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Zhang H, Zhao X, Yang X, Zhang X, Chen X, Zhou T, Xu X, Song M, Luo S, Xie Z, Xu Y, Shi J. Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis. Injury 2023; 54:422-428. [PMID: 36414499 DOI: 10.1016/j.injury.2022.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effect of internal fixation vs. external fixation after debridement in stage I of the Masquelet technique for Cierny-Mader (C-M) type Ⅳ chronic post-traumatic tibial osteomyelitis. METHODS This retrospective observational study included patients with tibial osteomyelitis who underwent staged treatment with the Masquelet technique between January 2016 and June 2020 at the 920 Hospital of Joint Logistic Support Force of the PLA. The patients were grouped according to the fixation they received after stage I. Infection recurrence, time to radiological bone healing and full weight-bearing, self-rating anxiety scale (SAS) score, Hospital for Special Surgery (HSS) Knee Score, and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were compared. RESULTS Sixty-three patients were included (50 males and 13 females). There were 40 and 23 patients with internal and external fixation, respectively. There were no significant differences between the two groups regarding the preoperative and intraoperative data (all P>0.05). After stage I operation, the infection control rates were 85.0% and 82.6% in the internal and external fixation groups (P=0.803), and these rates were 92.5% and 95.7% after stage II (P=0.621). There were no differences in the SAS scores (P=0.278), time to radiological union (P=0.795), time to full weight-bearing (P=0.725), AOFAS scores (P=0.302), HSS scores (P=0.085), and complication rates (P=0.593). There were 27 times complications in 19 patients, with an incidence of 42.9%, without significant differences between groups. CONCLUSION There were no differences between the two fixation methods after debridement in stage I of the Masquelet technique for C-M type Ⅳ chronic post-traumatic tibia osteomyelitis.
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Affiliation(s)
- Hu Zhang
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Xingang Zhao
- Department of Orthopaedics, Taian Municipal Hospital, 1 Yincai Street, Taian 271000, China
| | - Xiaoyong Yang
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Xijiao Zhang
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Xingyu Chen
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Tianhua Zhou
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Xiaoyan Xu
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Muguo Song
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Shunji Luo
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China
| | - Zhao Xie
- Department of Orthopaedics, First affiliated hospital, Army Medical University, Chongqing 404199, China.
| | - Yongqing Xu
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China.
| | - Jian Shi
- Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China.
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Jia Q, Liu Y, Alimujiang A, Guo J, Chen D, Wang Y, Yusufu A, Ma C. Nine-year-long complex humeral nonunion salvaged by distraction osteogenesis technique: a case report and review of the literature. BMC Surg 2022; 22:77. [PMID: 35241038 PMCID: PMC8892714 DOI: 10.1186/s12893-022-01524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Humeral nonunion with significant bone loss or shortening is uncommon and poses a complex clinical problem. We present a case of humeral nonunion with a large segmental bone defect treated with the distraction osteogenesis technique and remedy the radial nerve palsy produced during distraction osteogenesis by forearm tendon transfers. The reconstruction of upper limb function was achieved with satisfactory results. This case provides a referenceable alternative method for repairing large segmental bone defects due to complex nonunion of the upper extremity, as well as a remedy in the unfortunate event of radial nerve palsy, providing a reference and lessons learned for the treatment of similar cases and the management of possible complications. Case presentation A 31-year-old male patient experienced 9 years of hypertrophic nonunion due to an unreliable internal fixation. The radiographs showed the absence of bone bridging between the two fragments, loosening of the screws, and extensive osteolysis around the internal screws. The patient was treated with distraction osteogenesis. At the end of the distraction period, the patient unfortunately developed right radial nerve paresis, which was salvaged by forearm tendon transplantation, and finally reconstructed hand function and achieved bone union of the humerus. Conclusion Distraction osteogenesis, although not a panacea for all humeral nonunions with significant segmental bone loss, does offer a viable salvage procedure in this unusual and often complex clinical problem. When irreversible radial nerve palsy occurs during distraction, forearm tendon transfers can have a good clinical effect.
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Affiliation(s)
- Qiyu Jia
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Abudusalamu Alimujiang
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jian Guo
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dongsheng Chen
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yingbo Wang
- College of Chemical Engineering, Xinjiang Normal University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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VICENTI G, OTTAVIANI G, BIZZOCA D, CARROZZO M, SIMONE F, GROSSO A, ZAVATTINI G, ELIA R, MARUCCIA M, SOLARINO G, MORETTI B. The management of post-traumatic bone defects: a systematic review. MINERVA ORTHOPEDICS 2022; 73. [DOI: 10.23736/s2784-8469.21.04116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Evaluation of Bone Consolidation in External Fixation with an Electromechanical System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The monitoring of fracture or osteotomy healing is vital for orthopedists to help advise, if necessary, secondary treatments for improving healing outcomes and minimizing patient suffering. It has been decades since osteotomy stiffness has been identified as one main parameter to quantify and qualify the outcome of a regenerated callus. Still, radiographic imaging remains the current standard diagnostic technique of orthopedists. Hence, with recent technological advancements, engineers need to use the new branches of knowledge and improve or innovate diagnostic technologies. An electromechanical system was developed to help diagnose changes in osteotomy stiffness treated with the external fixator LRS Orthofix®. The concept was evaluated experimentally and numerically during fracture healing simulation using two different models: a simplified model of a human tibia, consisting of a nylon bar with a diameter of 30 mm, and a synthetic tibia with the anatomical model from fourth-generation Sawbones®. Moreover, Sawbones® blocks with different densities simulated the mechanical characteristics of the regenerated bone in many stages of bone callus growth. The experimental measurements using the developed diagnostic were compared to the numerically simulated results. For this external fixator, it was possible to show that the displacement in osteotomy was always lower than the displacement prescribed in the elongator. Nevertheless, a relationship was established between the energy consumption by the electromechanical system used to perform callus stimulus and the degree of osteotomy consolidation. Hence, this technology may lead to methodologies of mechanical stimulation for regenerating bone, which will play a relevant role for bedridden individuals with mobility limitations.
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Wen Y, Liu P, Wang Z, Li N. Clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture. BMC Geriatr 2021; 21:488. [PMID: 34493200 PMCID: PMC8425085 DOI: 10.1186/s12877-021-02409-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/03/2021] [Indexed: 12/21/2022] Open
Abstract
Objective This study was designed for the first time to analyze clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture. Methods This study retrospectively analyzed 220 older patients with infectious bone nonunion after open tibial fracture. There were 110 patients receiving bone transport technology (Group A) and 110 patients receiving membrane induction technique with antibiotic bone cement (Group B). Results There were 164 male patients and 56 female patients, with an age range of 65 to 71 years and an average age of 67 ± 1.3 years. Traffic accident, high-fall injury and crush injury account for 45.5, 27.7 and 26.8%, respectively. Age, gender, histories, causes and fracture location had no significant difference between the two groups (P > 0.05 for all). Operation time in the Group A was significantly shorter than that in the Group B (P < 0.05). Linear and positional alignment (70.9 vs. 57.3), American Knee Society knee function score (167.7 ± 14.9 vs. 123.8 ± 15.7), Baird-Jackson ankle function score (89.9 ± 3.5 vs. 78.4 ± 4.9), bone healing index (43.0 ± 2.0 vs. 44.3 ± 3.0) and clinical recovery (8.2 vs. 4.5) of patients in the Group A were significantly better than those in the Group B (P < 0.05 for all). Wound infection in the Group A (7.3%) was significantly less than that in the Group B (16.4%; P < 0.05). There were neither a neurovascular complication nor a recurrence of infection in the two groups. Conclusion Bone transport technology achieved better knee and ankle joint function recovery and superior bone healing and clinical efficacy than membrane induction technique with antibiotic bone cement, suggesting that bone transport technique is worthy of extensive promotion to improve clinical condition of older patients with infectious bone nonunion after open tibial fracture.
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Affiliation(s)
- Ying Wen
- Orthopedics Department, Harbin No. 5 Hospital, Harbin, 150040, China
| | - Peiming Liu
- Orthopedics Department, Harbin No. 5 Hospital, Harbin, 150040, China
| | - Zhichao Wang
- Orthopedics Department, Harbin No. 5 Hospital, Harbin, 150040, China
| | - Ning Li
- Orthopedics Department, Harbin No. 5 Hospital, Harbin, 150040, China.
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Li R, Zeng C, Yuan S, Chen Y, Zhao S, Ren GH. Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects. J Int Med Res 2021; 49:3000605211017618. [PMID: 34044634 PMCID: PMC8168033 DOI: 10.1177/03000605211017618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.
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Affiliation(s)
- Runguang Li
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China.,Department of Orthopedics, Linzhi People's Hospital, Linzhi, China
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China
| | - Song Yuan
- Department of Orthopedics, Linzhi People's Hospital, Linzhi, China
| | - Yirong Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanwen Zhao
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, Guangzhou, China
| | - Gao-Hong Ren
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Ren GH, Li R, Hu Y, Chen Y, Chen C, Yu B. Treatment options for infected bone defects in the lower extremities: free vascularized fibular graft or Ilizarov bone transport? J Orthop Surg Res 2020; 15:439. [PMID: 32972459 PMCID: PMC7513326 DOI: 10.1186/s13018-020-01907-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract Objective The objective was to explore the relative indications of free vascularized fibular graft (FVFG) and Ilizarov bone transport (IBT) in the treatment of infected bone defects of lower extremities via comparative analysis on the clinical characteristics and efficacies. Methods The clinical data of 66 cases with post-traumatic infected bone defects of the lower extremities who underwent FVFG (n = 23) or IBT (n = 43) from July 2014 to June 2018 were retrieved and retrospectively analyzed. Clinical characteristics, operation time, and intraoperative blood loss were statistically compared between two groups. Specifically, the clinical efficacies of two methods were statistically evaluated according to the external fixation time/index, recurrence rate of deep infection, incidence of complications, the times of reoperation, and final functional score of the affected extremities. Results Gender, age, cause of injury, Gustilo grade of initial injury, proportion of complicated injuries in other parts of the affected extremities, and numbers of femoral/tibial defect cases did not differ significantly between treatment groups, while infection site distribution after debridement (shaft/metaphysis) differed moderately, with metaphysis infection little more frequent in the FVFG group (P = 0.068). Femoral/tibial defect length was longer in the FVFG group (9.96 ± 2.27 vs. 8.74 ± 2.52 cm, P = 0.014). More patients in the FVFG group presented with moderate or complex wounds with soft-tissue defects. FVFG treatment required a longer surgical time (6.60 ± 1.34 vs. 3.12 ± 0.99 h) and resulted in greater intraoperative blood loss (873.91 ± 183.94 vs. 386.08 ± 131.98 ml; both P < 0.05) than the IBT group, while average follow-up time, recurrence rate of postoperative osteomyelitis, degree of bony union, and final functional scores did not differ between treatment groups. However, FVFG required a shorter external fixation time (7.04 ± 1.72 vs. 13.16 ± 2.92 months), yielded a lower external fixation index (0.73 ± 0.28 vs. 1.55 ± 0.28), and resulted in a lower incidence of postoperative complications (0.87 ± 0.76 vs. 2.21±1.78, times/case, P < 0.05). The times of reoperation in the two groups did not differ (0.78 ± 0.60 vs. 0.98 ± 0.99 times/case, P = 0.615). Conclusion Both FVFG and IBT are effective methods for repairing and reconstructing infected bone defects of the lower extremities, with unique advantages and limitations. Generally, FVFG is recommended for patients with soft tissue defects, bone defects adjacent to joints, large bone defects (particularly monocortical defects), and those who can tolerate microsurgery.
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Affiliation(s)
- Gao-Hong Ren
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Runguang Li
- Department of Orthopedics, Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,Orthopaedic Hospital of Guangdong Province, Guangzhou, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, China.,Department of Orthopedics, Linzhi people's hospital, Linzhi, China
| | - Yanjun Hu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yirong Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chaojie Chen
- Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Borzunov DY, Kolchin SN, Malkova TA. Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved. World J Orthop 2020; 11:304-318. [PMID: 32572367 PMCID: PMC7298454 DOI: 10.5312/wjo.v11.i6.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use. AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes. METHODS Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded. RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion. CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
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Affiliation(s)
- Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
| | - Sergei N Kolchin
- Orthopaedic Department 4, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
| | - Tatiana A Malkova
- Department for Medical Information and Analysis, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
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The Effect of External Fixator Configurations on the Dynamic Compression Load: An Experimental and Numerical Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app10010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
(1) Objective: External fixation systems are commonly used by surgeons to ensure stabilization and consolidation of bone fractures, especially in patients who are at high risk for systematic complications. Both rigid and elastic external fixations are important in the fracture healing process. This study aims to evaluate the behavior of the Orthofix Limb Reconstruction System (LRS)® in the dynamic compression mode. (2) Methods: Experimental and numerical setups were developed using a simplified model of a human tibia which consisted of a nylon bar with a diameter of 30 mm. The bone callus was included in both setups by means of a load cell-based system, which consisted of two carbon epoxy laminated composite plates with a final stiffness of 220 N/mm. The system was evaluated experimentally and numerically, considering different numbers of pins and comparing distances between the external fixator frame and the bone, achieving a good correlation between experimental and numerical results. (3) Results: The results identified and quantified the percental load transferred to the fracture and its sensibility to the distance between the external fixator and bone. Additionally, LRS locking stiffness was evaluated which resulted from the clamp-rail clearances. The results show that the blocking effects of the free clamp movement are directly related to the fixator configuration and are responsible for changes in the amount of load that crosses the bone callus. (4) Conclusions: From the biomechanical point of view, the results suggest that the average bending span of Schanz pins and the weights of the patients should be included into clinical studies of external fixators comparisons purpose.
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Yikemu X, Tuxun A, Nuermaimaiti M, Abudukeyimu A, Shayiti A. Effects of Vacuum Sealing Drainage Combined with Ilizarov Bone Transport Technique in the Treatment of Tibial Traumatic Osteomyelitis. Med Sci Monit 2019; 25:6864-6871. [PMID: 31513555 PMCID: PMC6754706 DOI: 10.12659/msm.915450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this study was to analyze the efficacy of vacuum sealing drainage combined with Ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis and risk factors for postoperative pin infection. Material/Methods We enrolled 78 patients with tibial traumatic osteomyelitis admitted at the First People’s Hospital of Kashgar from January 2015 to September 2017 and treated with vacuum sealing drainage combined with Ilizarov bone transport technique. Results After combined treatment, SAS and SDS scores decreased significantly, while SF-36 scores increased significantly. Comparisons showed that there were significant differences in the scores of patients after treatment (P<0.05). Univariate analysis showed that there were no significant differences in gender, BMI, hypertension, diabetes mellitus, COPD, smoking index, alcohol abuse history, or residence (P>0.05). There were significant differences in age, fracture type, fixation type, pin loosening, and indwelling time between the 2 groups (P<0.05). Multivariate logistic analysis showed that age, fracture type, fixation type, pin loosening, and indwelling time were independent risk factors for pin infection. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis. Conclusions Combination of vacuum sealing drainage with Ilizarov bone transport technique can effectively improve the condition of tibial traumatic osteomyelitis, improve the quality of life of patients, and reduce the occurrence of adverse emotions of patients. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.
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Affiliation(s)
- Xirenijiang Yikemu
- Department of Orthopedics, The First People's Hospital of Kashgar, Kashgar, Xinjiang, China (mainland)
| | - Aikebaier Tuxun
- Department of Orthopedics, The First People's Hospital of Kashgar, Kashgar, Xinjiang, China (mainland)
| | - Mireadili Nuermaimaiti
- Department of Orthopedics, The First People's Hospital of Kashgar, Kashgar, Xinjiang, China (mainland)
| | - Abudula Abudukeyimu
- Department of Orthopedics, The First People's Hospital of Kashgar, Kashgar, Xinjiang, China (mainland)
| | - Abuduleaila Shayiti
- Department of Orthopedics, The First People's Hospital of Kashgar, Kashgar, Xinjiang, China (mainland)
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Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol 2019; 20:22. [PMID: 30993461 PMCID: PMC6468024 DOI: 10.1186/s10195-019-0527-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Critical-sized bone defects of the tibia are complex injuries associated with significant problems that are difficult to treat, and they are associated with a significant burden of disease in clinical practice; however, the treatment of these cases has still been a challenge for orthopedic surgeons. The aim of this review was to evaluate the current available studies reporting on classical Ilizarov methods in the treatment of infected or noninfected critical-sized bone defects of the tibia, and to perform an analysis of treatment period and complications. Methods This is a narrative review based on a comprehensive literature search among the studies in Pubmed, Scopus and Web of Science articles. The studies included were written in the English language or translated to English and they were published between 2008 and 2018. They were appraised with narrative data synthesis. The primary outcome measures were the external fixation time (EFT), bone union rate, and bone and functional results. Secondary outcomes were complications including docking site problems and solutions. The heterogeneity of the data in the studies which were taken into consideration allowed a narrative analysis. Results Twenty-seven articles with 619 patients were included in this study. These included 6 prospective and 21 retrospective case series. Mean age was 36.1 (range 13–89) years. Of the cases, 88.8% were infected and the remaining 11.2% were noninfected. The external fixation time was 10.75 (range 2.5–23.2) months. The mean bone union rate was 90.2% (range 77–100)%. Radiographic outcome measures were reported in 20 studies. Functional outcome measures were reported in 18 studies. ASAMI (Association for the Study of the Method of Ilizarov) criteria are useful and give reproducible data on patient outcome measurements. Data collected from these studies showed excellent radiological outcomes in 303, good in 143, fair in 31, and poor in 25 patients. Functional outcomes were excellent in 200, good in 167, fair in 58, and poor in 19, where reported. The excellent and good rate in bone results and functional results were 88.8% and 82.6%, respectively. The poor rate in bone results and functional results were 5% and 4.5%. Mean complication rate per patient was 1.22 (range 3–60). The most common complication was pin tract infection (PTI). Its occurrence was 46.6%. Joint stiffness followed PTI with a 25% incidence. The rates of refracture, malunion, infectious recurrence, and amputation, were 4%, 8.4%, 4.58%, and 1%, respectively. Conclusions This narrative review shows that the patients with infected or noninfected critical-sized tibial bone defects treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected or noninfected tibial bone defects. The small number of cases in some studies, the absence of homogenity between studies and the fact that most data available are derived from retrospective studies are some of the difficulties encountered in the evaluation of evidence. Level of evidence V.
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Affiliation(s)
- Kemal Aktuglu
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey.
| | - Kubilay Erol
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey
| | - Arman Vahabi
- Department of Orthopedics and Traumatology, Ege University, Talatpasa Bulvari, Sezik Apt., No: 61/3 Alsancak, Izmir, Turkey
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Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2018; 100:1436-1442. [PMID: 30106829 DOI: 10.2106/jbjs.18.00584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Reggie C Hamdy
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Shriners Hospital for Children, Montreal, Quebec, Canada.,McGill University Health Center, Montreal, Quebec, Canada
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Yusufu A. [Hot spots of recent research in bone lengthening]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:849-853. [PMID: 30129307 PMCID: PMC8435958 DOI: 10.7507/1002-1892.201806064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/03/2022]
Abstract
Bone lengthening technique is one of the core surgical technique for skeletal lengthening and reconstruction. It is widely used in the treatment of nonunion, segmental bone defect, bone infection, congenital or post-traumatic limb length differences, and hand-foot deformity correction. Until today, the surgical techniques and devices of bone lengthening are improving over time, and it is to improve the quality of treatment and reduce complications. However, the bone lengthening technique is different from the treatment for other orthopedic diseases, and it has the following feature, including requiring multiple steps, longer treatment course, and application of external fixator. This article will summarize the hot research in the field of bone lengthening treatment in recent years and provide reference for future clinical treatment.
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Affiliation(s)
- Aihemaitijiang Yusufu
- Department of Microsurgical and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumchi Xinjiang, 830054,
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The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect. Injury 2017; 48:2842-2846. [PMID: 29122280 DOI: 10.1016/j.injury.2017.10.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.
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