A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur

Abstract

BackgroundInfected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods.MethodsA comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI). Bone results (excellent, good, fair and poor rate), functional results (excellent, good, fair and poor rate) and complications were analyzed by Stata 9.0.FindingsA total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04–0.12; I2 = 44.1%, P = 0.065) and 10% (95%CI, 0.05–0.14; I2 = 34.7%, P = 0.121) in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%.ConclusionsOur systematic review showed that the patients with infected nonunion of tibia and femur 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 nonunion of tibia and femur.

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

“…Furthermore, recurrence of infection is common, affecting 10% to 20% of patients [11][12][13][14]. A structured approach, with adequate debridement, excision of necrotic tissue, antimicrobial therapy and reconstruction of the bone and soft tissues, is of immense importance to eradicate infection and restore function [15][16][17]. To manage the resulting bone defects, distraction osteogenesis techniques such as Ilizarov acute shortening with bifocal relengthening (ASR) and bone transport (BT) have been shown to be effective treatment options to achieve union and infection clearance [1,12,15,16,18].…”

Ilizarov Ring Fixator in the Management of Infected Nonunion of Tibia - A Clinical Study

“…A systematic review and meta-analysis of Ilizarov methods in treatment of infected non-unions by Yin et al (4) revealed an average bone union rate of 97.26%. Among the 590 patients with infected non-union of tibia and femur who were included in the review, the poor rate in bone results and functional results was only 8% and 10% respectively which was similar to that obtained in our study.…”

Ilizarov Fixator in Femoral Supracondylar Fractures: A Case Series with 1 - 6 - Year Follow-up

“…Also, it aids to create the repair of angulation, multiplanar stability, and rotation at the nonunion place (1,5). The current study reported the experience at a teaching hospital to manage femoral supracondylar fractures fixed by Ilizarov technique.…”

“…Femoral supracondylar fracture contains 4% -7% of all femoral fractures (1). These fractures usually occur in females over 50 years old due to injury in a fall when walking and osteopenia, and in younger patients (males 15 -50 years) due to road accidents and sports injuries (1)(2)(3).…”

“…These fractures usually occur in females over 50 years old due to injury in a fall when walking and osteopenia, and in younger patients (males 15 -50 years) due to road accidents and sports injuries (1)(2)(3). Supracondylar femoral fracture happens in the distal (9 cm) of the femur between the diaphyseal -metaphyseal junction and the femoral condyle (2).…”