Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia

Rohilla, Rajesh; Siwach, Karan; Devgan, Ashish; Singh, Roop; Wadhwani, Jitendra; Ahmed, Naseem

doi:10.1016/j.jcot.2016.02.016

Cited by 38 publications

(29 citation statements)

References 23 publications

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“…In our study, the mean external fixation index was 1.43 months/cm, and the complications was 1.9 per patient; this was quite similar with the results by Paley and Maar [ 19 ] ; their study consisted of 19 patients, the result showed 22 minor and 19 major complications, and the complications were 2.2 per patient. Our results showed an obviously higher complication rate when compared with previous literature, [ 4 , 5 , 8 , 9 , 19 ] whereas all of patients in this study suffered tibial infected nonunion, experienced with multiple previous treatment failures, even in the presence of poor soft tissue coverage; this was an obvious difference from aforementioned studies. Pin-track infection was the most frequently observed complication in the course of bone transport in previous reports, [ 4 , 5 , 8 , 9 , 19 ] and this complication was also noted frequently in our study without a negative impact on the final outcome.…”

Section: Discussioncontrasting

confidence: 77%

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

et al. 2017

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The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20–55 years). All patients previously undergone an average of 2.9 operations (range: 1–6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3–12 cm), and all patients were suffering from soft tissue defects (range: 5–17 cm2). The mean external fixator time (EFT) was 48 weeks (range: 30–62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33–62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0–3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

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Section: Discussioncontrasting

confidence: 77%

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

et al. 2017

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“…Many surgical procedures have been proposed for the treatment of bone defect [3][4][5][6], and bone transport technique using the Ilizarov method is widely practiced in reconstructive surgery [7][8][9][10]. The Ilizarov method is based on the biology of the bone and the ability of the surrounding soft tissues to regenerate under tension stress, so it become the main treatment option for the reconstruction of bone defect due to it is characterized by rapid, simple, effective and minimally invasive, which can preserve the biomechanical microenvironment needed for fracture healing [9,[11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Yushan

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: The treatment of large bone defects in lower limbs is a serious challenge for orthopedic surgeons and patients. The bone transport technique using the Ilizarov method has become the main treatment option for the reconstruction of bone defect. However, inevitable difficulties and complications related to bone transport technique have been reported by many studies. 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 of 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 minimum of 2 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. There were 189 problems, 166 obstacles and 406 complications (257 minor and 149 major complications), and 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. Conclusion: Bone transport is a reliable method for reconstruction of bone defects in the femur and tibia. Awareness of predictable complications is beneficial to prevent or early detection of the expected complication which can improve the risk-benefit balance.

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“…In our study, an external fixator was placed over the preexisting IMN using the principles of lengthening over an IMN [11][12][13][14]. According to the principles of the Ilizarov technique, circular external fixation permits to fill up bone defects by corticotomy and bone transport after debridement [15,16].…”

Section: Discussionmentioning

confidence: 99%

Bifocal Bone Transport over a Preexisting Nail to Treat a Septic Femoral Shaft Nonunion

Tsibidakis

Guerreschi

Fakhry

et al. 2019

Case Rep Orthop Res

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Intramedullary nailing is the method of choice for the treatment of most femoral shaft fractures. However, it is not always an easy procedure with predictable results as leg length discrepancy as well as rotational and angular malunion may occur. Lengthening over an intramedullary nail (IMN) has become very common as it allows early removal of the external fixator. This report presents a case of an open femoral shaft fracture initially treated with an IMN and subsequently complicated by a septic nonunion. Union was obtained by bifocal bone transport with a circular external fixator over the preexisting nail without exchange or removal of the previously inserted IMN. In conclusion, the presence of an IMN supports osteotomy and regenerates bone during bone healing, prevents fracture and/or deformation of the regenerated bone, and reduces the time needed for the external fixator.

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Outcome of distraction osteogenesis by ring fixator in infected, large bone defects of tibia

Cited by 38 publications

References 23 publications

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia

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

Bifocal Bone Transport over a Preexisting Nail to Treat a Septic Femoral Shaft Nonunion

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