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López-Carreño E, Avendaño EL, Rojas LP, Martínez-Castellanos A, Rodríguez IA, López CG, Huerta HC, Huerta LF. Effective Compression and a Minimally Invasive Rail Plate to Optimize Bone Transport in Distraction Osteogenesis: New Concepts. JB JS Open Access 2024; 9:e23.00144. [PMID: 39629264 PMCID: PMC11596425 DOI: 10.2106/jbjs.oa.23.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
Background Bone transport in distraction osteogenesis is an effective, well-known procedure. However, bone compression is an aspect of this technique for which there is no objective information. The lack of direct bone compression measurements may result in a lack of uniformity in the bone transport process, which can result in its ineffective application and may be contributing to its underutilization. This study describes the results of applying objectively measured compressions to achieve a distraction regeneration zone and docking site consolidation during bone transport in distraction osteogenesis. Methods This prospective study describes the results of a single cohort of 32 patients who underwent distraction osteogenesis with bone transport utilizing a combination of a minimally invasive rail plate and monolateral external fixation. The patients were categorized into 2 groups: (1) those with hypertrophic, atrophic, or infectious pseudarthrosis-nonunion (the pseudarthrosis-nonunion group), and (2) those with bone loss due to trauma or osteomyelitis (the bone loss group). The initial bone compression was measured during the latency phase, and the final compression was measured during the distraction phase. The healing index, external fixation index, healing time, consolidation time, and docking time were calculated for each patient. The Mann-Whitney U and Kruskal-Wallis tests were used for comparisons between and within groups. Results In this study, 28 (88%) of the patients were male. The mean patient age was 44.93 ± 16.21 years. The median values were 3.2 Nm for the initial compression and 3.4 Nm for the final compression, with no significant difference between or within groups of patients. The osseous results were excellent in 29 patients (91%), and the functional results were good or excellent in 31 patients (97%). Conclusions This study is the first to objectively measure compression in the bone transport process. Our findings showed that all patients who had an initial compression of ≥3.2 Nm achieved 100% consolidation of the distraction regeneration zone, and those who had a final compression of ≥2.9 Nm achieved complete docking site consolidation without complications. These 2 values thus represent effective compression and highlight the role of bone compression in bone transport. Level of Evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- E. López-Carreño
- Orthopedic Surgery Department, Hospital Cl 50, Mexican Social Security Institute (I.M.S.S), San Luis Potosí, México
- Orthopedic Surgery Department, Medical Orthopedic Specialty Group TUORTOPEDISTA, Colorines, San Luis Potosí, México
| | - E.P. López Avendaño
- Orthopedic Surgery Department, Medical Orthopedic Specialty Group TUORTOPEDISTA, Colorines, San Luis Potosí, México
| | | | | | - I. Arámbula Rodríguez
- Orthopedic Surgery Department, Hospital Cl 50, Mexican Social Security Institute (I.M.S.S), San Luis Potosí, México
- Orthopedic Surgery Department, Medical Orthopedic Specialty Group TUORTOPEDISTA, Colorines, San Luis Potosí, México
| | - C. García López
- Orthopedic Surgery Department, Hospital Cl 50, Mexican Social Security Institute (I.M.S.S), San Luis Potosí, México
| | - H. Campos Huerta
- Orthopedic Surgery Department, Hospital Cl 50, Mexican Social Security Institute (I.M.S.S), San Luis Potosí, México
| | - L. Flores Huerta
- Orthopedic Surgery Department, Hospital Cl 50, Mexican Social Security Institute (I.M.S.S), San Luis Potosí, México
- Orthopedic Surgery Department, Medical Orthopedic Specialty Group TUORTOPEDISTA, Colorines, San Luis Potosí, México
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Necula RD, Grigorescu S, Necula BR. Orthoplastic Reconstruction of Distal Tibia High-Energy Fractures Using a Circular External Fixator-A Systematic Review. J Clin Med 2024; 13:5700. [PMID: 39407767 PMCID: PMC11476398 DOI: 10.3390/jcm13195700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/10/2024] [Accepted: 09/18/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications.
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Affiliation(s)
| | | | - Bogdan-Radu Necula
- Faculty of Medicine, “Transilvania” University, 500036 Brasov, Romania; (R.-D.N.); (S.G.)
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Xuming W, Changbao W, Yanping D, Qudong Y, Sheng S. Are the outcomes of bone transport in the treatment of bone defects in the upper- middle and lower-middle tibia similar? Acta Orthop Belg 2024; 90:513-521. [PMID: 39851024 DOI: 10.52628/90.3.12619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2025]
Abstract
The aim of the study was to compare the outcomes of bone transport in treating upper- middle vs. lower- middle tibial bone defects. Sixty-two patients with tibial infected large segmental defects treated by bone transport were analyzed retrospectively and divided into distal group (lower- middle tibial bone defects and proximal transport, n=38) and proximal group (upper- middle tibial bone defects and distal transport, n=24). The demographic data were not significant different (P > 0.05). External fixation index (ETI), bone defect union time (BDUT), regenerate consolidation time (RCT), bone healing and functional outcomes evaluated by Association for the Study and Application of the Methods of Ilizarov score, postoperative complications evaluated by Paley classification, and the American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded and compared at a minimum follow-up of 20 months. There were no significant differences in flap repair, follow-up time, ETI, RCT, bone healing, functional outcomes and complications between the two groups (P > 0.05). However, in the distal group, the BDUT was significantly longer, and the AOFAS score was significantly lower than those in the proximal group (17.5±2.5 vs 15.9±3.1 months, 70.0±5.5 vs 72.8±4.8, respectively) (P < 0.05). The overall outcomes of bone transport in treating upper- middle vs. lower- middle tibial bone defects are similar. However, the upper- middle tibia bone defects heal faster than the lower- middle tibial bone defects, and distal transport has a greater adverse effect on the ankle and foot joints than proximal transport. Therefore, traditional distal tibial transport near the ankle joint should be taken with caution.
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Zang J, Wei F, Shi L, Qin S. The Principle of Limb Reconstruction-"One Walking, Two Lines, and Three Balances": A Retrospective Analysis of Post-Traumatic Lower Limb Deformity Correction. Orthop Surg 2024; 16:2252-2263. [PMID: 39243193 PMCID: PMC11572569 DOI: 10.1111/os.14215] [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: 06/17/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE The principles of limb reconstruction are crucial for treatment success, but there is no unified standard for complex limb deformities. The aim of this study was to analyze the characteristics of the cases of post-traumatic lower limb deformity and explore the new principle of limb reconstruction. METHOD A retrospective analysis was conducted of 148 patients with post-traumatic lower limb deformity who underwent surgery from May 1978 to December 2023; 85 were males (57.4%) and 63 were females (42.6%); 65 cases of left side (43.9%), 79 cases of right side(53.4%), and 4 cases were on both sides (2.7%), the average age was 24.64 years (5-69). There were 4 cases suffering hip deformities, 40 cases of femoral deformities, 18 cases from knee, 40 cases from tibiofibular, 93 cases of foot and ankle deformities, and some patients also had two or more types. All patients underwent surgical intervention in an average of 40.5 months (12-96) after injury. According to the evaluation of limb deformities, deformity correction and functional reconstruction with external fixation were implemented, following the principle of "one walking, two lines, and three balances." The clinical evaluation adopts the criteria of Qinsihe lower limb deformity correction and functional reconstruction. RESULT 148 patients with post-traumatic lower limb deformities were followed up for 40.9 (12-356) months. The main surgical procedures implemented were tendon lengthening and soft tissue release (84 cases), osteotomy (93 cases), joint fusion (30 cases), and tendon transposition (16 cases); there were multiple surgical procedures in some patients. Among them, 124 cases used external fixators for stress control and 27 cases used internal fixation, while 3 cases used plaster or brace. There were 5 wire reactions postoperatively, which improved after dressing change and oral antibiotics. There were 2 pin infections, which improved by pin removing. No surgical related deep infections occurred, and no surgical related neurovascular damage occurred. At the last follow-up, all limb deformities were corrected, limb function improved, and the results of treatment was very satisfactory. According to Qinsihe evaluation criteria for lower limb deformities, 74 cases were excellent, 56 cases good, and 18 cases fair, with an excellent and good rate of 87.84%. CONCLUSION Stress control with external fixation is effective, safe, and controllable in correcting and reconstructing post-traumatic lower limb deformities. The principle of "one walking, two lines, and three balances" plays an important role in the entire process of stress control limb reconstruction.
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Affiliation(s)
- Jiancheng Zang
- Department of Orthopaedic SurgeryRehabilitation Hospital of the National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Fangyuan Wei
- Department of Orthopaedic SurgeryRehabilitation Hospital of the National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Lei Shi
- Rehabilitation Hospital of the National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Sihe Qin
- Rehabilitation Hospital of the National Research Center for Rehabilitation Technical AidsBeijingChina
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Shi B, Zhang Z, Ji G, Cai C, Shu H, Ma X. Bone Transport for Large Segmental Tibial Defects Using Taylor Spatial Frame versus the Ilizarov Circular Fixator. Orthop Surg 2024; 16:2157-2166. [PMID: 39105307 PMCID: PMC11572580 DOI: 10.1111/os.14192] [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: 06/04/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE Bone transport has become the gold standard for treating large segmental tibial bone defects. The technique for application the Ilizarov circular fixator (ICF) has a long learning curve and is associated with many complications. There are few clinical studies on bone transport via the Taylor spatial frame (TSF). The main purpose of this study was to compare the radiological and clinical and outcomes of bone transport by using the TSF and the ICF. METHODS There were 62 patients included in this retrospective study from June 2011 to June 2021 and distributed to two groups according to the fixation method: a TSF group consisting of 30 patients and an ICF group consisting of 32 patients. Demographic information, surgical duration, external fixation times, external fixation index, final radiographic results, complications, and clinical outcomes were recorded and examined. The clinical outcomes were assessed using the ASAMI criteria during the most recent clinical visit. Then, statistical analysis such as independent-samples t tests or chi-Square test was performed. RESULTS The mean surgical duration in the TSF group was 93.8 ± 7.3 min, which was shorter than that in the ICF group (109.8 ± 1.4 min) (p < 0.05). Compared to the ICF group (10.2 ± 2.0 months), the TSF group (9.7 ± 1.8 months) had a shorter average external fixation time (p > 0.05). The external fixation index was 1.4 ± 0.2 m/cm and 1.5 ± 0.1 m/cm in the two groups. Moreover, there was no significant difference between the two groups. At the last follow-up visit, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) in the TSF group were 88.1 ± 12.1° and 80.9 ± 1.3°, respectively. The MPTA and PPTA in the ICF group were 84.4 ± 2.4° and 76.2 ± 1.9°, respectively. There were statistically significant differences between the two groups (all p < 0.05). The complication rate was 50% in the TSF group and 75% in the ICF group. Moreover, the ASAMI score between the two groups was no statistically significant difference (p > 0.05). CONCLUSION No statistically significant difference was found in clinical outcomes between the use of Taylor spatial frame and Ilizarov circular fixator for treating large segmental tibial bone defects. However, TSF is a shorter and simpler procedure that causes fewer complications and improves limb alignment.
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Affiliation(s)
- Bowen Shi
- Clinical School of OrthopedicsTianjin Medical UniversityTianjinChina
- Department of Orthopedic TraumatologyTianjin HospitalTianjinChina
| | - Zhongli Zhang
- Clinical School of OrthopedicsTianjin Medical UniversityTianjinChina
- Department of Pediatric OrthopedicsTianjin HospitalTianjinChina
| | - Guoqi Ji
- Department of Orthopedic TraumatologyTianjin HospitalTianjinChina
| | - Chengkuo Cai
- Department of Orthopedic TraumatologyTianjin HospitalTianjinChina
| | - Hengsheng Shu
- Department of Orthopedic TraumatologyTianjin HospitalTianjinChina
| | - Xinlong Ma
- Department of Orthopedic TraumatologyTianjin HospitalTianjinChina
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Zhang Q, Kang Y, Wu Y, Ma Y, Jia X, Zhang M, Lin F, Rui Y. Masquelet combined with free-flap technique versus the Ilizarov bone transport technique for severe composite tibial and soft-tissue defects. Injury 2024; 55:111521. [PMID: 38584076 DOI: 10.1016/j.injury.2024.111521] [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: 01/29/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) versus the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. METHODS We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n = 35) was treated with the MFFT and internal fixation, and group B (n = 30) was treated with the IBTT. RESULTS The mean follow-up period was 28 months (range 13-133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3-12 months) in group A and 11 months (range 6-23 month) in group B, with a significant difference between the two groups (Z = -4.11, P = 0.001). The mean hospital stay was 28 days (range 14-67 d) in group A which was significantly longer than the mean stay of 18 days (range 10-43 d) in group B (Z = -2.608, P = 0.009). There were no significant differences in the infection rate between group A (17.1 %) and group B (26.7%) (χ2 = 0.867, P = 0.352). The Total Physical Health Scores were 81.51 ± 6.86 (range 67-90) in group A and 75.83±16.14 (range 44-98) in group B, with no significant difference between the two groups (t = 1.894, P = 0.063). The Total Mental Health Scores were significantly higher in group A (90.49 ± 6.37; range 78-98) than in group B (84.70 ± 13.72; range 60-98) (t = 2.232, P = 0.029). CONCLUSION Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited.
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Affiliation(s)
- Qingqing Zhang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Yongqiang Kang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China; Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Yongwei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Mingyu Zhang
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Yongjun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China.
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Sobolevskiy Y, Rushay A, Burianov O, Lisaichuk Y, Kvasha V, Kovalchuk D, Omelchenko T. OPTIMIZING DISTRACTION OSTEOSYNTHESIS IN PATIENT WITH THE TIBIAL SEGMENT TISSUE LOSS AFTER FRACTURES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2738-2743. [PMID: 36591762 DOI: 10.36740/wlek202211205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim: Improving treatment outcomes in patients with segment tibial bone tissue loss after fractures by improving the ring fixators technology. PATIENTS AND METHODS Materials and methods: The study includes the data of 77 patients. The patients were distributed between two groups: the main and control one, using random numbers table. The inclusion criteria were: patients' consent, their age over 18 years, tissue inflammation episodes, fibular defects 4-5cm in size and disseminated scar lesions. RF was applied with the proposed improvements. Finally, a semi-rigid external fusion system Softcast / Scotchcast was used to prevent deformation of the regenerate and create optimal conditions for fusion of fragments. RESULTS Results: The following results were obtained for the Modified Functional Evaluation System by Karlstrom-Olerud: positive treatment outcomes in the main group made up 97.1%, and 92.9% in the control one. Though, the specific gravity of good and excellent outcomes in the main group was 82.8%, while in the comparison group - just 45.2. CONCLUSION Conclusions: Along with considerable positive advantages of the "Ilizarov's" apparatus, some disadvantages have been noted. Elimination of the drawbacks is stipulated for the practical needs, which requires further scientific study.
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Behr B, Lotzien S, Flecke M, Wallner C, Wagner JM, Dadras M, Daigeler A, Schildhauer TA, Lehnhardt M, Geßmann J. Comparative analysis of clinical outcome and quality of life between amputations and combined bone and flap reconstructions at the lower leg. Disabil Rehabil 2022; 44:6744-6748. [PMID: 34546826 DOI: 10.1080/09638288.2021.1971309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE At the lower leg, soft tissue defects with exposed bones, tendons, or hardware require flap coverage. In this retrospective study, we analyzed combined bone and soft tissue reconstructions compared to amputations of the lower leg in a civilian setting. MATERIALS AND METHODS Patients who underwent combined bone and flap reconstruction (LR) or amputation (LA) of the lower leg were eligible for the study. Bone conditions included fractures and bony defects due to posttraumatic osteomyelitis and non-union. Besides the analysis of the medical history, the study included clinical examination including extremity functional scale (LEFS) and SF-36-questionnaire. RESULTS LEFS score was significantly higher in the LR group compared to the LA group. Importantly, 42% in the LR group as opposed to 80% in the LA group could not return to their occupation. Mean hospitalization was 119 in the LR and 49 days in the LA group. SF-36 body item scores were significantly higher in the LR group as compared to LA. CONCLUSIONS Patients undergoing complex extremity reconstructions, including flap transfer to the lower leg have better functionality and higher quality of life than amputated patients. These data emphasize the advantages of these procedures and justify reconstructive efforts for limb salvage. Level of Evidence III.Implications for RehabilitationAmputation and combined bone and flap reconstruction in severe injuries of the lower leg can imply functional disabilities even after successful treatment.Albeit longer hospitalizations, patients with complex reconstructions showed better functional outcomes and had a higher quality of life.Limb salvage showed better functional outcomes and a higher rate in reintegration to work as compared to limb amputation.These data emphasize the importance of complex bone and soft tissue reconstruction in this patient cohort.
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Affiliation(s)
- Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcel Flecke
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - J Maximillian Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Xu YJ, Gao X, Ding H, Bu XM, Wang HB, Wu B. Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report. Medicine (Baltimore) 2022; 101:e30149. [PMID: 35984144 PMCID: PMC9388036 DOI: 10.1097/md.0000000000030149] [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] [Indexed: 01/05/2023] Open
Abstract
RATIONALE To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury. PATIENT CONCERNS AND DIAGNOSIS Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3-10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function. INTERVENTIONS All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited. OUTCOMES Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73-90) days. The bone transport time was 97 (88.3-105.3) days, and the bone mineralization time was 164.5 (156.8-181.3) days, and the healing time of the docking sites was 6.8 (6.1-8.3) months. The external fixator time was 14.5 (12.5-17) months with the external fixation index was 1.5 (1.4-1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases. LESSONS One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.
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Affiliation(s)
- Ying-Jie Xu
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xu Gao
- Department of Qingdao Medical College, Qingdao University, Qingdao City
| | - Hao Ding
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xian-Min Bu
- Department of Pathology, Jining No. 1 People’s Hospital
| | - Hai-Bin Wang
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, China
| | - Bin Wu
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, China
- *Correspondence: Bin Wu, Department of Orthopedic, Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining City 272029, Shandong Province, China (e-mail: )
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Song X, Shao X. Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9052770. [PMID: 35872947 PMCID: PMC9307362 DOI: 10.1155/2022/9052770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 12/05/2022]
Abstract
Objective To investigate the effect of annular external fixator-assisted bone transport in the treatment of traumatic massive bone defect of tibia on clinical healing, pain stress, and joint function. Methods From January 2018 to November 2021, 146 patients with traumatic massive bone defect of tibia were selected as the research objects, and they were divided into observation group (annular external fixator-assisted bone transport, 71 cases) and control group (unilateral external fixator bone lengthening, 75 cases) according to different surgical methods. The therapeutic efficacy, fracture healing-related indexes, and postoperative range of motion of the knee joint were compared between the two groups. Callus healing was evaluated by Fernandez-Esteve callus score, and joint function was evaluated by Paley score, American Knee society score (AKSS), and Baird-Jackson ankle score. The changes of pain mediator (serum substance P (SP), neuropeptide Y (NPY), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α)) and stress indexes (adrenocorticotropic hormone (ACTH), cortisol (COR), and nor Epinephrine (NE)) were observed before and after treatment in two groups. The incidence of postoperative complications was analyzed. Results There were no significant differences in total effective rate and bone lengthening between the two groups (P > 0.05). The bone healing time and callus formation time in the observation group were shorter than those in the control group, and the Fernandez-Esteve callus score was higher than that in the control group (P < 0.05). The levels of SP, NPY, PGE2, TNF-α, ACTH, COR, and NE in the observation group were lower than those in the control group (P < 0.05). AKSS and Baird-Jackson scores in the observation group after operation were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion Annular external fixator-assisted bone transport can promote postoperative fracture healing, reduce pain stress level, and improve joint function of patients with traumatic massive bone defect of tibia.
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Affiliation(s)
- Xiaoliang Song
- Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
- Department of Orthopaedics, Changzhi Second People's Hospital, Changzhi, Shanxi 046000, China
| | - Xinzhong Shao
- Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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11
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Abulaiti A, Liu Y, Cai F, Liu K, Abula A, Maimaiti X, Ren P, Yusufu A. Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study. Front Surg 2022; 9:858240. [PMID: 36034365 PMCID: PMC9406520 DOI: 10.3389/fsurg.2022.858240] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19–65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit. Results All patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05). Conclusion Both the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.
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Papagiannis S, Sinos G, Vrachnis I, Balasis S, Kouzelis A. A Case of Reconstruction of an Open Tibial Fracture (Gustilo-Anderson Type IIIB) With Severe Skin and Bone Loss Using Corticocancellous Bone Plugs From the Iliac Crest and an Ilizarov Frame. Cureus 2022; 14:e22549. [PMID: 35345712 PMCID: PMC8956481 DOI: 10.7759/cureus.22549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
Gustilo-Anderson type IIIB fractures include open fractures with extensive soft tissue injury with periosteal stripping and bony exposure. They are usually associated with massive contamination and can be challenging even for experienced surgeons. A multidisciplinary approach among plastic and trauma surgeons is often required. We present a case of a 58-year-old man with a type IIIB open tibial fracture initially managed with a bridging external fixation and primary skin closure using a fasciocutaneous sural flap. Two months later, there was no evidence of fracture healing and an Ilizarov device was applied with corticotomy at the proximal tibial metaphysis, which was modified five months later without changing the frame, placing autogenous iliac bone plugs at the fracture site using the mosaicplasty harvesting technique. Seven months after its initial placement, the Ilizarov device was removed allowing full weight-bearing, with callus formation present at 10-month follow-up. Finally, the patient showed acceptable radiological and functional outcomes after a follow-up of two years. The Ilizarov method should be considered as a therapeutic option for complicated open fractures with severe bone and skin loss. The patient should be fully informed about the complexity of these fractures and the necessity of multiple surgical interventions in order to have realistic expectations.
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13
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Laubscher M, Nieuwoudt L, Marais L. Effect of frame and fixation factors on the incidence of pin site infections in circular external fixation of the tibia: A systematic review of comparative studies. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2022. [DOI: 10.4103/jllr.jllr_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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14
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Rosteius T, Pätzholz S, Rausch V, Lotzien S, Behr B, Lehnhardt M, Schildhauer TA, Seybold D, Geßmann J. Ilizarov bone transport using an intramedullary cable transportation system in the treatment of tibial bone defects. Injury 2021; 52:1606-1613. [PMID: 33436268 DOI: 10.1016/j.injury.2020.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Segmental tibia defects remain challenging for orthopedic surgeons to treat. The aim of this study was to demonstrate bone-related and functional outcomes after treatment of complex tibial bone defects using Ilizarov bone transport with a modified intramedullary cable transportation system (CTS). PATIENTS AND METHODS We conducted a single-center, retrospective study including all 42 patients treated for tibial bone loss via Ilizarov bone transport with CTS between 2005 and 2018. Bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Complication and failure rates were determined by the patients' medical files. RESULTS Patients had a mean age of 45.5 ± 15.1 years. The mean bone defect size was 7.7 ± 3.4 cm, the average nonunion scoring system (NUSS) score was 59 ± 9.5 points, and the mean follow-up was 40.8 ± 24.4 months (range, 13-139 months). Complete bone and soft tissue healing occurred in 32/42 patients (76.2%). These patients had excellent (10), good (17), fair (2), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 19 patients had excellent, 10 good, and 3 fair results. In total, 37 minor complications and 62 major complications occurred during the study. In 7 patients, bone and soft tissue healing occurred after CTS failure with either an induced membrane technique or classic bone transport; 3 patients underwent lower leg amputation. Patients with treatment failure were significantly older (57.6 vs. 41.8 years; p = 0.003). Charlson score and treatment failure had a positive correlation (Spearman's rho 0.43; p = 0.004). CONCLUSION Bone transport using both intramedullary CTS and Ilizarov ring fixation is viable for treating patients with bone loss of the tibia and complex infection or soft tissue conditions. However, a high number of complications and surgical revisions are associated with the treatment of this severe clinical entity and should be taken into account.
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Affiliation(s)
- Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiological Diagnostics, Interventional Radiology and Nuclear Medicine, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Markus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Dominik Seybold
- OPND Orthopädie Unfallchirurgie Praxis/Klinik Neuss, Plange Mühle 1, 40221 Düsseldorf, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
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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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16
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Xu YQ, Fan XY, He XQ, Wen HJ. Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases. BMC Musculoskelet Disord 2021; 22:34. [PMID: 33413256 PMCID: PMC7788851 DOI: 10.1186/s12891-020-03894-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. METHODS We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2-18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. RESULTS The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2-2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. CONCLUSION TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.
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Affiliation(s)
- Yong-Qing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Xin-Yu Fan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Xiao-Qing He
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031
| | - Hong-Jie Wen
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming Medical University, 212 Daguan Road, Xi Shan district, Kunming, Yunnan, People's Republic of China, 650031.
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17
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Ma Y, Yin Q, Wu Y, Wang Z, Sun Z, Gu S, Rui Y, Han X. Retraction of transporting bone segment during Ilizarov bone transport. BMC Musculoskelet Disord 2020; 21:704. [PMID: 33106160 PMCID: PMC7590790 DOI: 10.1186/s12891-020-03702-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. METHODS The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. RESULTS Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance(p < 0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance(p > 0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p < 0.05), but the transport distance was not (p > 0.05). CONCLUSION The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.
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Affiliation(s)
- Yunhong Ma
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Zongnan Wang
- Department of Orthopaedics, Shuyang People's Hospital, Suqian, 223000, Jiangsu, China
| | - Zhenzhong Sun
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Xiaofei Han
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
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18
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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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Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique? BIOMED RESEARCH INTERNATIONAL 2020; 2020:2716547. [PMID: 32185197 PMCID: PMC7060447 DOI: 10.1155/2020/2716547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/26/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Objective To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.
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Wen H, Zhu S, Li C, Xu Y. Bone transport versus acute shortening for the management of infected tibial bone defects: a meta-analysis. BMC Musculoskelet Disord 2020; 21:80. [PMID: 32028924 PMCID: PMC7006089 DOI: 10.1186/s12891-020-3114-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 01/22/2023] Open
Abstract
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 = 0.63, 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 complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37). Conclusions AST is preferred from the aspect of minimising the treatment period, whereas 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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Affiliation(s)
- Hongjie Wen
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shouyan Zhu
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Canzhang Li
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yongqing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, NO. 212 Daguan Road, Xi Shan District, Kunming City, 650021, Yunnan Province, China.
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Luo X, Yilihamu Y, Liu A, Huang Y, Ou C, Zou Y, Zhang X. Replantation and Lengthening of a Lower Leg in a 7-Year-Old Child: A Case Report. J Foot Ankle Surg 2019; 58:1273-1275. [PMID: 31679680 DOI: 10.1053/j.jfas.2019.03.018] [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: 05/17/2018] [Revised: 01/22/2019] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
Replantation of the lower leg has controversial indications, but it may be considered in carefully selected patients. Although the function of prosthetic lower legs has been improved in recent decades, leg salvage remains a laudable goal. We present the case of a 7-year-old child who sustained a traumatic amputation at the level of the middle tibia with loss of the middle portion of the lower leg. We performed successful replantation, and tibia lengthening was performed starting 10 days after replantation and lasted 6 months.
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Affiliation(s)
- Xuchao Luo
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yilizati Yilihamu
- Surgeon, Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anming Liu
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yu Huang
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Changliang Ou
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yonggen Zou
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xu Zhang
- Surgeon, Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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