• Ilizarov
• flap
• lower limb
• open fracture
• reconstruction

• Humans
• Male
• Female
• Retrospective Studies
• Adult
• Tibia/surgery
• Middle Aged
• Treatment Outcome
• Young Adult
• Tibial Fractures/surgery
• Aged
• Adolescent

• External Fixator
• Ilizarov Technology
• Limb Reconstruction
• Post‐traumatic Lower Limb Deformity
• Stress Control

• Humans
• Retrospective Studies
• Male
• Female
• Adult
• Adolescent
• Young Adult
• Middle Aged
• Child
• Aged
• Child, Preschool
• Plastic Surgery Procedures/methods
• External Fixators

• Bone defects
• Bone transport
• External fixators
• Ilizarov technique
• Tibial fractures

• Humans
• Retrospective Studies
• Male
• Female
• Adult
• Middle Aged
• Ilizarov Technique
• External Fixators
• Tibial Fractures/surgery
• Tibial Fractures/diagnostic imaging
• Tibia/surgery
• Aged

• 2023YFC2507605 National Key Research and Development Program of China
• National Key Research and Development Program of China

• Bone defect
• Fracture
• Ilizarov technique
• Masquelet technique
• Soft tissue

• Humans
• Male
• Ilizarov Technique
• Soft Tissue Injuries/surgery
• Female
• Retrospective Studies
• Fractures, Open/surgery
• Adult
• Middle Aged
• Tibial Fractures/surgery
• Treatment Outcome
• Fracture Fixation, Internal/methods
• Free Tissue Flaps
• Plastic Surgery Procedures/methods
• Fracture Healing
• Aged
• Young Adult
• Bone Transplantation/methods
• Adolescent
• Debridement/methods

• bone defects
• fractures
• tissue loss

• LEFS
• SF-36
• amputation
• limb salvage
• quality of life

• external fixation
• ilizarov bone transport
• limb bone defect
• reascularization

• Adult
• External Fixators
• Humans
• Ilizarov Technique
• Lower Extremity
• Middle Aged
• Retrospective Studies
• Tibia/surgery
• Tibial Fractures/surgery
• Treatment Outcome
• Young Adult

• Adrenocorticotropic Hormone
• Dinoprostone
• External Fixators
• Humans
• Pain/complications
• Postoperative Complications
• Retrospective Studies
• Tibia/surgery
• Tibial Fractures/complications
• Tibial Fractures/surgery
• Treatment Outcome
• Tumor Necrosis Factor-alpha

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.

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.

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).

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.

• Foundation of Clinical Peak Discipline of Xinjiang Medical University
• National Natural Science Foundation of China

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.

• Bone defect
• Bone transport
• Distraction osteogenesis
• Intramedullary cable transportation system

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.

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.

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.

Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.

• Free flap transplantation
• Ilizarov bone transport
• clinical efficacy
• functional outcome
• open fracture
• soft tissue defect

• Bone transport
• Defects
• Ilizarov techniques
• Soft-tissue transport
• Tibia

• Bone transport
• Callus distraction
• Force
• Retraction of transporting bone segment

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.

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.

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).

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.

• Bone defect
• Bone infection
• Free vascularized fibular graft
• Ilizarov bone transport

• Bone defect
• Bone nonunion
• Bone transport
• Distraction osteogenesis
• Free vascularized grafts
• Ilizarov method
• Induced membrane technique complication

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.

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.

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.

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.

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.

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).

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).

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.

• Acute shortening
• Bone defects
• Bone transport
• Ilizarov technique
• Tibial

• lengthening
• lower leg
• replantation