Comparison of Clinico-radiological Outcomes of Monolateral Fixator in Infected Non-union of Tibia Based on Bone Gap Quantification

Wadhwani, Jitendra; Rohilla, Rajesh; Siwach, Ramchander; Singh, Roop; Devgan, Ashish; Vashishth, Sumedha

doi:10.1007/s43465-020-00053-2

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…STSG: 3 Br-sp. IV Abs × 5 days + oral × 2 wks 8.6 (5–18) nr 18 Jilani [ 44 ] 11.3 (8.3–22) 2.4 (1–5) Plastic cover: 8 cases (not specified) IV ABs x 4d Oral Abs till stitch removal 8.2 (7–19) 2 19 Sharma [ 45 ] 15 (12–26) 3 (2–5) nr As per culture sensitivity 3.8 (3–4.5) nr 20 Kinik [ 51 ] 32.5 (12–72) 2.9 (1–9) nr 3 wks: IV, 3 wks: oral 13.7 (8–27) nr 21 Baruah [ 46 ] (24–72) 5 Cross-leg: 2, local flaps: 5, STSG: 9 nr nr nr 22 Sigmund [ 47 ] 37.9: median (16–128) 2.8 (1–6) Muscle flaps: 17 Appropriate Abs: at least 6 wks 9.7 (5–17) 8 (5 BG + 3 BMPs) 23 Kushwaha [ 48 ] 29.5 (16–50) nr nr nr 11.2 (6–18) nr 24 Wadhwani [ 49 ] 35 (minimum 6 years post frame removal) ...…”

Section: Resultsmentioning

confidence: 99%

“…With regards to LoE, there were 2 RCTs (Level I) [ 43 , 54 ], 5 prospective cohort studies (Level II) [ 32 , 45 , 47 , 48 , 53 ] 7 retrospective comparative studies (Level III) [ 17 , 31 , 39 , 40 , 46 , 49 , 50 ] and 18 retrospective cohort studies (Level IV) [ 18 – 20 , 30 , 33 – 38 , 41 , 42 , 44 , 51 , 52 , 55 – 57 ] (Table 3 ). The overall risk of bias of both randomised prospective trials [ 43 , 54 ] was high, according to the RoB2 tool (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Wakefield,

Papakostidis,

Giannoudis

et al. 2023

Eur J Trauma Emerg Surg

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Introduction Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. As there is a paucity of data directly comparing the outcomes of these techniques, there is no universal agreement on which strategy a surgeon should choose to use. Aims This systematic review and meta-analysis aimed to summarize the outcomes of both DO and IMT, in terms of primary outcomes (bone union and infection elimination), and secondary outcomes (complication rates and functional outcomes). Methods A PRISMA strategy was used. Medline, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated using OCEBM and GRADE systems. Results Thirty-two studies with 1136 subjects met the inclusion criteria. With respect to the primary outcomes of interest, union was observed in 94.6% (DO method) and 88.0% (IMT method); this difference, however, was not significant between the two techniques (p = 0.45). In addition, infection elimination rates were also higher in the Ilizarov DO group when compared to Masquelet (Mq) IMT (93.0% vs 80.4% respectively). Again, no significant difference was observed (p = 0.06). For all secondary outcomes assessed (unplanned re-operations, re-fracture rates amputation rate), no statistically significant differences were documented between the treatment options. Conclusion This study demonstrated that there is no clinical difference in outcomes for patients treated with Ilizarov DO versus Mq IMT techniques. The evidence base at present is relatively sparse and, therefore, we would recommend for further Level I studies to be conducted, to make more meaningful conclusions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Wakefield,

Papakostidis,

Giannoudis

et al. 2023

Eur J Trauma Emerg Surg

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Which surgical technique may yield the best results in large, infected, segmental non-unions of the tibial shaft? A scoping review

Akhoundzadeh,

Bloemers,

Verhofstad

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Infected nonunion of the tibia with a large segmental bone defect is a complex and challenging condition for the patient and surgeon. This scoping review was conducted to identify existing evidence and knowledge gaps regarding this clinical scenario. Secondly, the objective of this study was to search for a valid recommendation on the optimal treatment. Methods A comprehensive search was conducted in the bibliographic databases: PubMed, Embase.com, and Web of Science Core Collection. Studies reporting on bone transport techniques, the Masquelet technique, and vascularized fibular grafts in bone defects greater than 5 cm were included. Bone healing results and functional results were compared according to duration of nonunion, infection recurrence, bone consolidation, complication rate, external fixation time, and time until full weight-bearing. Results Of the 2753 articles retrieved, 37 studies could be included on bone transport techniques (n = 23), the Masquelet technique (n = 7), and vascularized fibular grafts (n = 7). Respective bone union percentages were 94.3%, 89.5%, and 96.5%. The percentages of infection recurrence respectively were 1.6%, 14.4% and 7.0%, followed by respectively 1.58, 0.78, and 0.73 complications per patient. Conclusion Bone transport was found to be the most widely studied technique in the literature. Depending on the surgeon’s expertise, vascularized fibular grafts may be held as a favourable alternative. This review indicates that further high-quality research on large bone defects ($$\ge$$ ≥ 5 cm) in patients with infected tibial nonunions is necessary to gain more insight into the potentially beneficial results of vascularized fibular grafts and the Masquelet technique.

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Comparison of Clinico-radiological Outcomes of Monolateral Fixator in Infected Non-union of Tibia Based on Bone Gap Quantification

Cited by 2 publications

References 21 publications

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Which surgical technique may yield the best results in large, infected, segmental non-unions of the tibial shaft? A scoping review

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