Long bone reconstruction using multilevel lengthening of bone defect fragments

Borzunov, D.Yu.

doi:10.1007/s00264-012-1562-1

Cited by 75 publications

(98 citation statements)

References 15 publications

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“…But the practical application of the Ilizarov single level transport to bridge the defect gap in the range of six-12 cm required prolonged fixation in the frame or featured delayed regeneration [11][12][13][14]. Our results in group 1 show the possibility of bone stock gain at the expense of multilevel lengthening for a shorter total osteosynthesis period and prove our reported experimental findings of sufficient regeneration by multilevel distraction for defect filling [16].…”

Section: Discussionsupporting

confidence: 67%

“…It was shown that the docking site union was the main factor for Ilizarov frame removal as the time of regenerated bone remodelling during fixation would also be sufficient for the contacting regenerate remodelling to provide union at the docking site, independent of open or closed variants [10,11,16,17]. Therefore, the decision about the Ilizarov frame removal time should be one of the key moments during extensive defect management [11,16,17].…”

Section: Discussionmentioning

confidence: 99%

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Ilizarov non-free bone plasty for extensive tibial defects

Borzunov

Chevardin

2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to present a retrospective comparative overview of the Ilizarov non-free bone plasty techniques of one-stage multilevel fragment lengthening and gradual tibilisation of the fibula used for extensive tibial defect management. Methods Extensive tibial defects in 83 patients were managed either by multilevel fragment lengthening (group I, n=41, mean defect size 13.1±0.9 cm) or gradual tibilisation of the fibula (group II, n = 42, mean defect size 12.5 ± 1.2 cm) using the Ilizarov apparatus. The initial findings, treatment protocols and outcomes of those patients treated within the period 1972-2011 were studied retrospectively by medical records and radiographs, and statistically assessed with Microsoft Excel and Attestat software. Results Group I had multilevel fragment lengthening over one stage that averaged 288.0±14.4 days. The mean total period of gradual tibilisation of the fibula in group II was 316.0±29.7 days. The patient's age in the latter group had an effect on the completeness of leg-length equalisation. Conclusions The techniques can be used to manage extensive tibial defects as all the defects bridged, leg-length discrepancy and deformity were corrected and patients were able to load their limbs.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Ilizarov non-free bone plasty for extensive tibial defects

Borzunov

Chevardin

2013

International Orthopaedics (SICOT)

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“…The major disadvantage is time; the average time required for reconstruction is 10-12 months, and this may be a significant psychological burden to patients [107]. There are reports of using multiple corticotomies at different levels to decrease the overall time required for healing, but these methods are complicated and require meticulous frame management by both the patient and surgeon [108].…”

Section: Distraction Osteogenesismentioning

confidence: 99%

Clinical Aspects of Fracture Healing: An Overview

Liu

Buza

Leucht

2015

Clinic Rev Bone Miner Metab

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The assessment, diagnosis, and management of fractures, particularly fractures that exhibit delayed healing, present considerable unique challenges to both patients and physicians. Fracture healing results from a complex series of biochemical events that may produce complete restoration of the anatomic and biochemical properties of the original osseous tissue. Fracture healing requires appropriate reduction, mechanical stability, and adequate vascularity to the fracture site; compromise of one of these elements may lead to delayed healing or nonunion. The patient's history, physical examination, and findings based on radiographs or other imaging modalities allow for assessment and characterization of the progression of healing. If nonunion is recognized, it is important for the clinician to understand the current treatment options that are available to optimize healing. Physical stimulation therapies include electromagnetic stimulation and low-intensity pulsed ultrasonography. Osteogenic factors used locally to promote fracture healing include autologous bone marrow and peptide signaling molecules such as platelet-derived growth factors, fibroblast growth factors, and bone morphogenetic proteins. Systemic biological protein such as parathyroid hormone and factors that target the Wnt family of signaling molecules offers promising data regarding its abilities to promote healing. Large segmental defects must be managed depending on the type and severity of the injury and may require treatment with bone grafts, induced membrane techniques, acute shortening, or distraction osteogenesis. A systematic approach in evaluating fracture union and an understanding of the modern methods to promote fracture healing will allow clinicians to significantly improve the treatment of patients with these injuries.

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“…Duration of docking union was defined as total amount of time (days) required to develop the signs of union (presence of bridging trabeculae on three cortices and absence of pain on dynamization). Radiographs were reviewed monthly to monitor the quality of regenerate ASAMI Score Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria 19,22 . Bone results were evaluated based on union, infection, deformity, and limb length discrepancy and classified as excellent, good, fair, and poor.…”

Section: Duration Of Regenerate Consolidation and Docking Unionmentioning

confidence: 99%

“…The regeneration of a long bone defect by distraction of one osteotomy site in the bifocal technique takes a long time in the frame, which potentially increases the risk of complications. Borzunov et al 19 firstly proposed one stage double-level (trifocal technique) or multilevel bone transport for massive bone defects to shorten distraction time and external fixation time. Their clinical outcomes demonstrated that the duration of distraction could be reduced 2.5 times and fixation improved from 1.3 to 1.9 times with the double level technique compared with the traditional single level technique.…”

Section: Introductionmentioning

confidence: 99%

Bifocal or Trifocal (Double‐Level) Bone Transport Using Unilateral Rail System in the Treatment of Large Tibial Defects Caused by Infection: A Retrospective Study

Yushan

Ren

Abula

et al. 2020

Orthopaedic Surgery

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Objective The aim of this study is to assess the clinical results of bifocal or trifocal bone transport using unilateral rail system in the treatment of large tibial defects caused by infection. Methods There were a total of 37 eligible patients with an average age of 40.11 ± 10.32 years (range, 18–57 years; 28 males and nine females) with large tibial defects due to infection who were admitted to our hospital from June 2006 to June 2016. Among the patients, 21 underwent bifocal bone transport (BF group), and the remaining 16 were treated with trifocal bone transport (TF group). The demographic data (age, sex, interval duration before bone transport, previous operation time), intraoperative outcomes (size and location of the defect, size of soft tissue defect), postoperative variables (lengthening speed, external fixation index, duration of regenerate consolidation and docking union), postoperative bone and functional outcomes evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification (muscle contraction, axial deviation, delayed consolidation, pin problems, repeated fracture, joint stiffness and others) of the two groups were recorded and compared at a minimum follow‐up of 24 months. Results The mean duration of follow‐up after removal of fixator was 29.49 ± 4.34 months (range, 24–38 months). There was no statistically significant difference in the demographic data, intraoperative outcomes including size and location of the defect, size of soft tissue defect, as well as postoperative complications. However, postoperative functional result in the TF group were superior to those in the BF group at a minimum follow‐up of 24 months, and lengthening speed, external fixation index (EFI), duration of regenerate consolidation and docking union were significantly reduced in the TF group when compared with the BF group. Conclusions Treatment of large tibial defects caused by infection with trifocal bone transport using unilateral rail system could significantly improve postoperative functional recovery and reduce duration of regenerate consolidation and docking union. The present study provides novel insight for the treatment of large tibial defects caused by infection.

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Long bone reconstruction using multilevel lengthening of bone defect fragments

Cited by 75 publications

References 15 publications

Ilizarov non-free bone plasty for extensive tibial defects

Ilizarov non-free bone plasty for extensive tibial defects

Clinical Aspects of Fracture Healing: An Overview

Bifocal or Trifocal (Double‐Level) Bone Transport Using Unilateral Rail System in the Treatment of Large Tibial Defects Caused by Infection: A Retrospective Study

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