Comparison of Monolateral External Fixation and Internal Fixation for Skeletal Stabilisation in the Management of Small Tibial Bone Defects following Successful Treatment of Chronic Osteomyelitis

Wang, Yicun; Jiang, Hui; Deng, Zhong‐Liang; Jin, Jiewen; Meng, Jia; Wang, Jun; Zhao, Jianning; Sun, Guoqiang; Hu, Qian

doi:10.1155/2017/6250635

Cited by 12 publications

(6 citation statements)

References 32 publications

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“…When the infected site is close to the joint, transarticular fixation leads to joint stiffness [15], which is not conducive to the recovery of joint function. External fixation is bulky, which affects patients' ordinary life [16]. Long-term placement of the external fixation also has a negative impact on patients' mental health [17].…”

Section: Discussionmentioning

confidence: 99%

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Jia

Xiao-hua

et al. 2020

J Orthop Surg Res

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Background: The induced membrane technique has achieved good clinical results in the treatment of infected bone defects, and external fixation is the main method, but it causes inconvenience and complications in patients. In this study, our objective was to investigate the outcomes of using an antibiotic cement-coated locking plate as a temporary internal fixation in the first stage of the surgical induced membrane technique for treating extremities with infected bone defects. Methods: We retrospectively analysed patients with lower extremity infected bone defects in our department between January 2013 and December 2017. All patients were treated with the induced membrane technique. In the first stage, the defects were stabilized with an antibiotic cement-coated locking plate as a temporary fixation after debridement, and polymethyl methacrylate cement was implanted to induce the formation of a membrane. In the second stage, bone grafting rebuilt the bone defects after infection control, and the temporary fixation was changed to a stronger fixation. Results: A total of 183 patients were enrolled, with an average follow-up duration of 32.0 (12-66) months. There were 154 males and 29 females with an average age of 42.8 (10-68) years. The infection sites included 81 femurs, 100 tibias and 2 fibulas. After the first stage of treatment (infection control), 16 (8.7%) patients had recurrence of infection. In terms of the incidence of complications, 4 patients had poor wound healing, 2 patients had fixation failure and 1 patient had femoral fracture due to a fall. After the second stage of treatment (bone reconstruction), there were 24 (13.1%) recurrences of infection, with a mean time of 9.9 months (range 0.5 to 36). Among them, 18 patients underwent bone grafting after re-debridement, 6 received permanent placement of antibiotic bone cement after debridement and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175 (95.9%) patients at the last follow-up, and the average time to bone union was 5.4 (4-12) months. Conclusions: Antibiotic cement-coated locking plates have good clinical effects in the control of bone infection, but attention must be paid to the possible difficulty of skin coverage when applied in calves.

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Section: Discussionmentioning

confidence: 99%

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Jia

Xiao-hua

et al. 2020

J Orthop Surg Res

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“…[3] Debr. delayed CBG [26,36,44] Three stage [1] Debr. delayed CBG, delayed STC [33] Cancellous graft with AB [9] Two stage [6] Debr.…”

Section: Induced Membrane Techniquementioning

confidence: 99%

Management of critical-sized bone defects in the treatment of fracture-related infection: a systematic review and pooled analysis

Bezstarosti

Metsemakers

Lieshout

et al. 2020

Arch Orthop Trauma Surg

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Purpose This systematic review determined the reported treatment strategies, their individual success rates, and other outcome parameters in the management of critical-sized bone defects in fracture-related infection (FRI) patients between 1990 and 2018. Methods A systematic literature search on treatment and outcome of critical-sized bone defects in FRI was performed. Treatment strategies identified were, autologous cancellous grafts, autologous cancellous grafts combined with local antibiotics, the induced membrane technique, vascularized grafts, Ilizarov bone transport, and bone transport combined with local antibiotics. Outcomes were bone healing and infection eradication after primary surgical protocol and recurrence of FRI and amputations at the end of study period. Results Fifty studies were included, describing 1530 patients, the tibia was affected in 82%. Mean age was 40 years (range 6–80), with predominantly male subjects (79%). Mean duration of infection was 17 months (range 1–624) and mean follow-up 51 months (range 6–126). After initial protocolized treatment, FRI was cured in 83% (95% CI 79–87) of all cases, increasing to 94% (95% CI 92–96) at the end of each individual study. Recurrence of infection was seen in 8% (95% CI 6–11) and amputation in 3% (95% CI 2–3). Final outcomes overlapped across treatment strategies. Conclusion Results should be interpreted with caution due to the retrospective and observational design of most studies, the lack of clear classification systems, incomplete data reports, potential underreporting of adverse outcomes, and heterogeneity in patient series. A consensus on classification, treatment protocols, and outcome is needed to improve reliability of future studies.

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“…The study of Wang et al showed that there was no significant difference between the two methods for bone defects smaller than 4 cm, but external fixation showed a strong advantage instability when it was larger than 4 cm. 18 Currently, the more popular fixation technology is Ilizarov, which is not suitable for doctors in most grass-roots hospitals due to its long learning curve, long course of treatment, increased surgical trauma, and risk. Therefore, more studies may focus on simple and effective external fixation techniques in the treatment of bone defects in the future.…”

Section: Com Module Co-occurrence Results Analysismentioning

confidence: 99%

Research Status and Hotspots of Chronic Osteomyelitis: A Bibliometric and Visualized Analysis

Chen

Wang

et al. 2022

Orthopaedic Surgery

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Objective The treatment of chronic osteomyelitis (COM) is extremely challenging for physicians and patients. It is of great significance to explore the research status, development trend and future research hotspots in the field of COM to promote the development of this field. This study is aimed to explore the global research status of COM and predict its future research hotspots based on bibliometric and visualized analysis. Methods Web of Science core collection database was used to search the related literature of COM from 1994 to 2020. All data were imported into Microsoft Excel 2019 for collation. Additionally, the literature quality of countries, authors, journals, and institutions is evaluated. The VOS viewer software was used for conducting co‐analysis, co‐citation analysis, and keyword co‐occurrence analysis of literature to analyze the global status and predict the future hotspots of the COM field. Results A total of 726 articles were retrieved in this study. The number of global publications shows a trend of wave growth, but the increase is not significant. It is expected that the number of COM articles will remain at more than 50 per year in the next decade. The COM literature published in the United States (Publications = 160, H index = 37, average citations per item = 28.63) is of the highest quality. Girschick HJ (Publications = 16, H index = 14, average citations per item = 52.25) is the most contributed scholar in the field of COM. UNIV IOWA (Publications = 15, H index = 11, average citations per item = 57.27) and UNIV WURZBURG (Publications = 18, H index = 15, average citations per item = 47.5) are influential institutions in the field of COM. The results of co‐occurrence analysis show that the field of COM can be roughly divided into the following five modules: COM surgical research, COM basic research, COM diagnosis‐related research, chronic recurrent multifocal osteomyelitis (CRMO)‐related research, risk factors of COM. Risk factors of COM are the module with the highest concentration of hot words. Conclusion COM‐related research will continue to develop further in the next decade. The diagnosis research and risk factors of COM are the most popular research modules in recent years. Some controversial or troubled issues including the efficacy of perforator flap and fascia flap covering soft tissue, searching exclusive detection methods for the diagnosis of COM and bisphosphonates and biological agents in the treatment of CRMO may lead to the development of the COM field.

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Comparison of Monolateral External Fixation and Internal Fixation for Skeletal Stabilisation in the Management of Small Tibial Bone Defects following Successful Treatment of Chronic Osteomyelitis

Cited by 12 publications

References 32 publications

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Management of critical-sized bone defects in the treatment of fracture-related infection: a systematic review and pooled analysis

Research Status and Hotspots of Chronic Osteomyelitis: A Bibliometric and Visualized Analysis

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