Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years

Abstract

Background: The treatment of large bone defects in lower limbs is a serious challenge for orthopedic surgeons and patients. The bone transport technique according to the Ilizarov method characterized with versatile abilities and has become the main option for the reconstruction of bone defect. However, inevitable difficulties as complications related to bone transport technique have been reported by many studies. Complications which could affect on the clinical outcomes remain a major concern. The purpose of this study was to evaluate the effectiveness and complications of bone transport technique using Ilizarov method in the treatment of bone defect in lower extremity.Methods: The study was conducted on 282 patients who underwent bone transport procedures using Ilizarov method at our institution from January 2007 to June 2017. Patient’s demographic data, complications and clinical outcomes at two years follow-up were collected and retrospectively analyzed. All difficulties that related to bone transport were documented according to Paley’s classification. The clinical outcomes were evaluated using Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at last clinical visit.Results: There were 243 male and 39 females with a mean age of 40 years (range 18-65 years). The mean defect was 6.56±2.15 cm, whereas single level transport in 221 cases and double level transport in 61 cases. A total of 189 problems, 166 obstacles and 406 complications (257 minor and 149 major complications) were observed，the average complication rate per patients consists of 0.91 minor and 0.53 major complications. The top five complications were pin-site infection (65.96%), axial deviation (40.78%), joint stiffness (23.76%), soft tissue incarceration (22.34%) and delayed union of the docking site (13.48%).The ASAMI bony result was excellent in 233 patients, good in 32, fair in 5 and poor in 12. The ASAMI functional result was excellent in 136 patients, good in 88, fair in 47, poor in 11 and failure in 0.Conclusion: Bone transport is a reliable method for reconstruction of bone defects in the femur and tibia caused by variety of reasons. Particular attention, patient’s compliance and experience of the surgeon contribute the satisfactory results.

Ilizarov bone transport to treat infected nonunion of long bones: a multicenter retrospective cohort study

“…In our study, the rate of excellent and good bone healing was 77% and the rate of excellent and good functional recovery was 75%; these rates are not as high as those in previous studies. 20–22 Testa et al. 20 reported a 96% rate of excellent or good bone healing and an 84% rate of excellent or good functional recovery in their study.…”

“…Liu et al. 21 reported a 94% rate of excellent or good radiologic bone healing and a 79% rate of excellent or good functional results. Tetsworth et al.…”

Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

“…Unfortunately, the ability to obtain good bone quality faster was lost by bone transport in the distal as a result. Even the joint stiffness occurred here more and worse knee motion was brought, since the adjacent relationship to knee [15,[42][43][44]. Therefore, the quadriceps plasty methods and their modi cations may be a resolution to knee stiffness.…”

Reconstruction of Long Segmental Tibial Bone Defect Using the Bone Transport Compared to Acute Shortening and Re-lengthening : A Retrospective Study

“…Bone transport is often used to treat cases with large bone defects, and patients with small bone defects are generally managed by acute shortening/re-lengthening. However, patients with a long segmental bone defect who underwent the bone transport may suffer the axial deviation, long docking time, delayed union, or non-union [24,25]. And patients who underwent acute shortening/re-lengthening may experience various soft-tissue complications.…”