Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review

Abstract

Background Critical-sized bone defects of the tibia are complex injuries associated with significant problems that are difficult to treat, and they are associated with a significant burden of disease in clinical practice; however, the treatment of these cases has still been a challenge for orthopedic surgeons. The aim of this review was to evaluate the current available studies reporting on classical Ilizarov methods in the treatment of infected or noninfected critical-sized bone defects of the tibia, and to perform an analysis of treatment period and complications. Methods This is a narrative review based on a comprehensive literature search among the studies in Pubmed, Scopus and Web of Science articles. The studies included were written in the English language or translated to English and they were published between 2008 and 2018. They were appraised with narrative data synthesis. The primary outcome measures were the external fixation time (EFT), bone union rate, and bone and functional results. Secondary outcomes were complications including docking site problems and solutions. The heterogeneity of the data in the studies which were taken into consideration allowed a narrative analysis. Results Twenty-seven articles with 619 patients were included in this study. These included 6 prospective and 21 retrospective case series. Mean age was 36.1 (range 13–89) years. Of the cases, 88.8% were infected and the remaining 11.2% were noninfected. The external fixation time was 10.75 (range 2.5–23.2) months. The mean bone union rate was 90.2% (range 77–100)%. Radiographic outcome measures were reported in 20 studies. Functional outcome measures were reported in 18 studies. ASAMI (Association for the Study of the Method of Ilizarov) criteria are useful and give reproducible data on patient outcome measurements. Data collected from these studies showed excellent radiological outcomes in 303, good in 143, fair in 31, and poor in 25 patients. Functional outcomes were excellent in 200, good in 167, fair in 58, and poor in 19, where reported. The excellent and good rate in bone results and functional results were 88.8% and 82.6%, respectively. The poor rate in bone results and functional results were 5% and 4.5%. Mean complication rate per patient was 1.22 (range 3–60). The most common complication was pin tract infection (PTI). Its occurrence was 46.6%. Joint stiffness followed PTI with a 25% incidence. The rates of refracture, malunion, infectious recurrence, and amputation, were 4%, 8.4%, 4.58%, and 1%, respectively. Conclusions This narrative review shows that the patients with infected or noninfected critical-sized tibial bone defects 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 or noninfected tibial bone defects. The small number of cases in some studies, the absence of homogenity between studies and the...

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

“…In the present study, we used ASAMI scoring system to evaluate the effectiveness of the method of bone transport. The excellent and good rates of bony results was higher than that of functional results and these results were similar to other studies 15,35,36 .…”

“…Although the treatment of bone defect using bone transport technique has been used widely include reconstruction of the bone defect along with soft-tissue coverage, correction of the joint contractures or malalignment. However, inevitable difficulties and complications related to bone transport technique using the Ilizarov method have been reported by many studies 9,[13][14][15][16][17][18][19] . It is remaining a major concern to these complications which could affect on the clinical outcomes.…”

Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

“…Previously, the Ilizarov external xation technique was the most commonly used technique for large bone defects without soft tissue defects [8,20]. In recent years, an increasing number of studies have reported that bone transport with external xation can be used to simultaneously treat massive bone and soft tissue defects [5,9,21,22]. The technique of bone transport combined with soft-tissue transport (open bone transport) was rst proposed by Suger [23].…”

“…Large posttraumatic bone defects of the tibia combined with soft tissue defects are a common clinical problem. Currently, the treatment methods mainly include bone transport, the Masquelet technique, and free vascularised bone transfer [1][2][3][4][5][6][7][8][9]. For decades, bone transport has become recognised as optimal for the management of large posttraumatic tibial and soft tissue defects because of the complete eradication of infection, and powerful capacity for osteogenesis.…”

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

“…Even though critical-sized tibial bone defects are common, their treatment still represents a challenge. A strategy frequently used in orthopedic surgery is bone transport, which consists of the gradual and progressive translocation of a section of bone to the defect from an healthy area in proximity [100] . Traumatic injuries though, often present with open factures and soft tissue defects, increasing the risk of infections.…”