Histomorphometric characteristics of the tibialis anterior muscle and the peroneal nerve in experimental repair of post-resection tibial defect using the Ilizarov external fixation and the Masquelet technique

Mokhovikov, D.S.; Orthopedics, Kurgan; Ступина, Т. А.; Варсегова, Т. Н.; Дюрягина, О. В.; Еманов, А. А.; Borzunov, D.Yu.

doi:10.18019/1028-4427-2020-26-2-216-221

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“…Therefore, a combination of the biological merits of IBT and IMT seemed to us a promising strategy in the management of cases with a history of failed attempts and impaired regeneration potential. Following use of the combined technique in an experimental canine model[ 17 ], we aimed to conduct clinical studies on the use of this new technological solution that integrates the IMT and IBT techniques for treating non-viable tibial defects of post-traumatic (PTD) etiology and CPT to improve bone regeneration at the docking site, bone consolidation and reduce the refracture rate.…”

Section: Introductionmentioning

confidence: 99%

Ilizarov bone transport combined with the Masquelet technique for bone defects of various etiologies (preliminary results)

Borzunov¹,

Kolchin²,

Mokhovikov³

et al. 2022

WJO

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BACKGROUND The Ilizarov bone transport (IBT) and the Masquelet induced membrane technique (IMT) have specific merits and shortcomings, but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies, including congenital deficiencies. Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments. AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis, and present preliminary results of this technological solution. METHODS Seven adults with post-traumatic tibial defects (subgroup A) and nine children (subgroup B) with congenital pseudarthrosis of the tibia (CPT) were treated with the combination of IMT and IBT after the failure of previous treatments. The mean number of previous surgeries was 2.0 ± 0.2 in subgroup A and 3.3 ± 0.7 in subgroup B. Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal. Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane, its compression and docking for consolidation without grafting. The outcomes were retrospectively studied after a mean follow-up of 20.8 ± 2.7 mo in subgroup A and 25.3 ± 2.3 mo in subgroup B. RESULTS The “true defect” after resection was 13.3 ± 1.7% in subgroup A and 31.0 ± 3.0% in subgroup B relative to the contralateral limb. Upon completion of treatment, defects were filled by 75.4 ± 10.6% and 34.6 ± 4.2%, respectively. Total duration of external fixation was 397 ± 9.2 and 270.1 ± 16.3 d, including spacer retention time of 42.4 ± 4.5 and 55.8 ± 6.6 d, in subgroups A and B, respectively. Bone infection was not observed. Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups. Ischemic regeneration was observed in two cases of subgroup B. Complications were corrected during the course of treatment. Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B. One non-united CPT case was further treated with the Ilizarov compression method only and achieved union. After a follow-up period of two to three years, refractures occurred in four cases of united CPT. CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention. Refractures may occur in severe CPT.

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Section: Introductionmentioning

confidence: 99%