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Maheshwari V, Raja BS, Bahadur B, Regmi A, Dhingra M, Gowda AK. Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis. J Clin Orthop Trauma 2023; 40:102170. [PMID: 37293684 PMCID: PMC10245124 DOI: 10.1016/j.jcot.2023.102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/23/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Nonunion of long bones is a major complication following fractures that requires a substantial amount of investment both monetary and time from patients and surgeons. The need to comprehensively understand the complications, outcomes and distraction capability is profound, which necessitates a review of current evidence on special fixators used for distraction. The current systematic review aims to study the available literature on distraction osteogenesis using special fixators (Ilizarov and Limb Reconstruction System) in the management of nonunion (infected and non-infected). Methods Cochrane Library, PubMed, Scopus were searched until January 2022. The review included all original studies which used Ilizarov or Monorail Fixators/LRS in the treatment of nonunion of long bones. The quality of studies was assessed using the Modified Coleman Methodology Score. Results A total of 35 original studies with Ilizarov (n = 29) and LRS (n = 8) were selected including two comparative studies. The pooled data meta-analysis and the subgroup analysis of these studies found both Ilizarov and LRS fixator yield similar functional outcomes for the treatment of long bones nonunion. Conclusion The review was conducted to understand the scenario of nonunion in long bones. Pin tract infection is found to be the most common complication followed by adjacent joint stiffness and deformity. In our review we observed that both external fixator time and index were lower in LRS compared to Ilizarov group. Further RCT are required comparing Ilizarov and LRS fixators to effectively comment upon the superiority of the implants.
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Affiliation(s)
- Vikas Maheshwari
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India
| | - Bom Bahadur
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Anil Regmi
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Mohit Dhingra
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
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Kuroiwa Y, Fukui T, Takahara S, Lee SY, Oe K, Arakura M, Kumabe Y, Oda T, Matsumoto T, Matsushita T, Akisue T, Sakai Y, Kuroda R, Niikura T. Topical cutaneous application of CO 2 accelerates bone healing in a rat femoral defect model. BMC Musculoskelet Disord 2019; 20:237. [PMID: 31113412 PMCID: PMC6530028 DOI: 10.1186/s12891-019-2601-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bone defects may occur because of severe trauma, nonunion, infection, or tumor resection. However, treatments for bone defects are often difficult and have not been fully established yet. We previously designed an efficient system of topical cutaneous application of carbon dioxide (CO2) using a novel hydrogel, which facilitates CO2 absorption through the skin into the deep area within a limb. In this study, the effect of topical cutaneous application of CO2 on bone healing was investigated using a rat femoral defect model. METHODS In this basic research study, an in vivo bone defect model, fixed with an external fixator, was created using a rat femur. The affected limb was shaved, and CO2 was applied for 20 min/day, 5 days/week. In the control animals, CO2 gas was replaced with air. Radiographic, histological, biomechanical, and genetic assessments were performed to evaluate bone healing. RESULTS Radiographically, bone healing rate was significantly higher in the CO2 group than in the control group at 4 weeks (18.2% vs. 72.7%). The degree of bone healing scored using the histopathological Allen grading system was significantly higher in the CO2 group than in the control group at 2 weeks (1.389 ± 0.334 vs. 1.944 ± 0.375). The ultimate stress, extrinsic stiffness, and failure energy were significantly greater in the CO2 group than in the control group at 4 weeks (3.2 ± 0.8% vs. 38.1 ± 4.8%, 0.6 ± 0.3% vs. 41.5 ± 12.2%, 2.6 ± 0.8% vs. 24.7 ± 5.9%, respectively.). The volumetric bone mineral density of the callus in micro-computed tomography analysis was significantly higher in the CO2 group than in the control group at 4 weeks (180.9 ± 43.0 mg/cm3 vs. 247.9 ± 49.9 mg/cm3). Gene expression of vascular endothelial growth factor in the CO2 group was significantly greater than that in the control group at 3 weeks (0.617 ± 0.240 vs. 2.213 ± 0.387). CONCLUSIONS Topical cutaneous application of CO2 accelerated bone healing in a rat femoral defect model. CO2 application can be a novel and useful therapy for accelerating bone healing in bone defects; further research on its efficacy in humans is warranted.
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Affiliation(s)
- Yu Kuroiwa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shunsuke Takahara
- Department of Orthopaedic Surgery, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa, 675-8555, Japan
| | - Sang Yang Lee
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Michio Arakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Oda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Sawadogo M, Kafando H, Ouedraogo S, Tinto S, Tall M. Reconstruction of a Traumatic Bone Defect from Distal Femur. J Orthop Case Rep 2018; 8:30-32. [PMID: 30167408 PMCID: PMC6114198 DOI: 10.13107/jocr.2250-0685.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bone defect is a difficult problem in orthopedics. The treatment conventionally relies on techniques such as induced membrane, grafts, and elongations. The reintegration of an externalized osseous fragment involves significant infectious risks but is essential in certain situations. CASE REPORT We report the case of a 10 cm traumatic bone loss of the right distal femur in a 35-year-old woman. Treatment consisted of paring, reintegration and stabilization by the external fixative. The 5-year follow-up was satisfactory with good consolidation and good function of the limb. CONCLUSION The reintegration of a bone fragment of limb expelled onto the soil is rare. We tried it because the response time was very short, but also and especially because the fragment was expelled on very hot bitumen. These two elements limited the risk of infection and favored the osseointegration of the fragment. We have not found a similar case reported in the literature allowing comparisons and recommendations.
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Affiliation(s)
- Mamoudou Sawadogo
- Department of Surgery, Regional University Hospital, Ouahigouya, Burkina Faso
| | - H Kafando
- Department of Orthopedics-Traumatology, Hospital Center University Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - S Ouedraogo
- Department of Surgery, Regional University Hospital, Ouahigouya, Burkina Faso
| | - S Tinto
- Department of Orthopedics-Traumatology, Hospital Center University Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M Tall
- Department of Orthopedics-Traumatology, Hospital Center University Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Obremskey W, Molina C, Collinge C, Tornetta P, Sagi C, Schmidt A, Probe R, Ahn J, Nana A. Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part B: Management of Segmental Long Bone Defects. A Survey of Orthopaedic Trauma Association Members. J Orthop Trauma 2014; 28:e203-7. [PMID: 26057886 DOI: 10.1097/bot.0000000000000034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Treatment of segmental long bone defects is one of the areas of substantial controversy in current orthopaedic trauma. The main purpose of this survey was to determine current practice and practice variation within the Orthopaedic Trauma Association (OTA) membership on this topic. DESIGN Survey. SETTING Web-based survey. PARTICIPANTS Three hundred seventy-nine orthopaedic trauma surgeons. METHODS A 15-item questionnaire-based study titled "OTA Open Fracture Survey" was constructed. The survey was delivered to all OTA membership categories. Different components of the data charts were used to analyze various aspects of open fracture management, focusing on definitive treatment and materials used for grafting in "critical-sized" segmental bone defects. RESULTS Between July and August 2012, a total of 379/1545 members responded for a 25% response rate. Overall, 89.5% (339/379) of respondents use some sort of antibiotic cement spacer before bone grafting. It was found that 92% of respondents preferred to use some type of autograft at time of definitive grafting of segmental defects. When using a grafting technique, 88% said they used some type of antibiotic cement. Within that context, 60.1% said graft placement should be done at 6 weeks. CONCLUSIONS There continues to be substantial variation in the timing of bone graft placement after soft tissue healing and the source and form of graft used. The use of antibiotic cement is common in segmental defects that require delayed bone grafting. Obtaining base-line practice characteristics on controversial topics will help provide a foundation for assessing research needs and, therefore, goals. LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William Obremskey
- *Orthopaedic Trauma Institute, Vanderbilt University Medical Center, Nashville, TN; †Department of Orthopaedic Surgery, John Peter Smith, Fort Worth, TX; ‡Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA; §Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; ‖Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; ¶Department of Orthopaedic Surgery, Scott & White Healthcare, Temple, TX; and **Orthopaedic Trauma and Fracture Service, Hospital of the University of Pennsylvania, Philadelphia, PA
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Blondel B, Launay F, Jacopin S, Jacquemier M, Jouve JL, Bollini G. Limb lengthening using ankle joint distraction (arthrodiastasis) followed by arthrodesis. Experience with one case. Orthop Traumatol Surg Res 2011; 97:438-42. [PMID: 21546331 DOI: 10.1016/j.otsr.2010.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 11/18/2010] [Accepted: 12/09/2010] [Indexed: 02/02/2023]
Abstract
Tibial aplasias are difficult entities to manage and sometimes require significant limb lengthening. Preserving the joint is the preferred option in these cases. However, when function is not ensured, lengthening beginning in the joint can be attempted followed by arthrodesis. This report presents the clinical and radiological results of a patient treated with intra-articular lengthening (or arthrodiastasis) associated with talocrural arthrodesis. Although this original technique provided satisfactory results, this surgical program remains complicated.
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Affiliation(s)
- B Blondel
- Pediatric surgery and orthopaedics department, Mediterranean university, Marseille Timone Children Hospital, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Uzel AP, Lemonne F, Casoli V. Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane. ORTHOPAEDICS & TRAUMATOLOGY, SURGERY & RESEARCH : OTSR 2010; 96:194-8. [PMID: 20417920 DOI: 10.1016/j.rcot.2010.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 08/24/2009] [Indexed: 02/07/2023]
Abstract
The management of combined loss of skin coverage and bone substance in the lower third of the leg is problematic. A recommended sequential strategy associates removal of infected tissue and coverage followed by treatment of the bone defect. We report a technique without microsurgery, using Masquelet's induced membrane technique to manage the bone loss, associated to bone transport and coverage by a fasciocutaneous flap with distal pedicle. In a patient presenting with a 10 cm defect with bone exposure, this 2-step procedure allowed consolidation at 7 months without functional sequelae; the fixator was kept in place for 9 months. Neither microsurgery nor cancellous bone graft was required. Using a spacer to induce a membrane facilitated bone transport and distal consolidation.
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Affiliation(s)
- A-P Uzel
- Orthopedics and Traumatology Department, Pointe-à-Pitre Regional Teaching Hospital, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe.
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