1
|
Xie L, Huang Y, Zhang L, Si S, Yu Y. Ilizarov method and its combined methods in the treatment of long bone defects of the lower extremity: systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:891. [PMID: 37968675 PMCID: PMC10652567 DOI: 10.1186/s12891-023-07001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Ilizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods. METHODS Studies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique. RESULTS Sixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity. CONCLUSION Our study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.
Collapse
Affiliation(s)
- Lijun Xie
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, P. R. China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, P. R. China
| | - Ye Huang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Libi Zhang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Shuting Si
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Yunxian Yu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China.
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China.
| |
Collapse
|
2
|
Toros T, Ozaksar K. Reconstruction of traumatic tubular bone defects using vascularized fibular graft. Injury 2021; 52:2926-2934. [PMID: 31455503 DOI: 10.1016/j.injury.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/10/2019] [Indexed: 02/02/2023]
Abstract
Large segmental bone defects due to major trauma constitute a major challenge for the orthopaedic surgeon, especially when combined with poor or lost soft tissue envelope. Vascularized fibular transfer is considered as the gold standard for the reconstruction of such defects of the extremities due to its predictable vascular pedicle, long cylindrical shape, and tendency to hypertrophy, and resistance to infection. Vascularized bone grafts remain viable throughout the healing period and are capable of inducing rapid graft union without prolonged creeping substitution, osteogenesis and hypertrophy at the reconstruction site, and fight with infection. The fibular graft can be transferred solely, or as a composite flap including muscle, subcutaneous tissue, skin and even a nerve segment in order to reconstruct both bone and soft tissue components of the injury at single stage operation. Such a reconstruction can even be performed in the presence of local infection, since vascularized bone and adjacent soft tissue components enhances the blood flow at the traumatized zone, allowing for the delivery of antibiotics and immune components to the infection site. In an effort to preserve growth potential in pediatric patients; the fibular head and proximal growth plate can be included to the graft. This practice also enables to reconstruct the articular ends of various bones, including distal radius and proximal ulna. Apart from defect reconstruction, vascularized fibular grafts also proved to be a reliable in treating atrophic nonunions, reconstruction of osteomyelitic bone segments. These grafts are superior to alternative reconstructive techniques, as bone grafts with intrinsic blood supply lead to higher success rates in reconstruction and accelerate the repair process at the injury site in cases where blood supply to the injury zone is defective, poor soft tissue envelope, and local infection at the trauma zone.
Collapse
Affiliation(s)
- Tulgar Toros
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey.
| | - Kemal Ozaksar
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey
| |
Collapse
|
3
|
Abdou SA, Stranix JT, Daar DA, Mehta DD, McLaurin T, Tejwani N, Saadeh PB, Levine JP, Leucht P, Thanik VD. Free Tissue Transfer with Distraction Osteogenesis and Masquelet Technique Is Effective for Limb Salvage in Patients with Gustilo Type IIIB Open Fractures. Plast Reconstr Surg 2020; 145:1071-1076. [PMID: 32221236 DOI: 10.1097/prs.0000000000006696] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Osteocutaneous reconstruction can be challenging because of concomitant injuries and limited donor sites. There is a paucity of data on limb salvage outcomes following combined soft-tissue reconstruction and bone transport or Masquelet procedures. The authors reviewed a consecutive series of open tibia fracture patients undergoing soft-tissue reconstruction with either distraction osteogenesis or Masquelet technique. Endpoints were perioperative flap complications and bone union. Fourteen patients with Gustilo type IIIB open tibia fractures were included. Half of the group received muscle flaps and the remaining half received fasciocutaneous flaps. Ten patients (71.4 percent) underwent distraction osteogenesis and the remaining patients underwent Masquelet technique. Average bone gap length was 65.7 ± 31.3 mm (range, 20 to 120 mm). In the bone transport group, the average external fixation duration was 245 days (range, 47 to 686 days). In the Masquelet group, the average duration of the first stage of this two-stage procedure (i.e., time from cement spacer placement to bone grafting) was 95 days (range, 42 to 181 days). Bone union rate, as determined by radiographic evidence, was 85.7 percent. There was one complete flap failure (7.1 percent). One patient underwent below-knee amputation after failing bone transport and developing chronic osteomyelitis and subsequent infected nonunion. Our case series demonstrates that nonosteocutaneous flap methods of limb reconstruction are a viable option in patients with segmental long bone defects, with a bone union rate of 85 percent and a limb salvage rate over 90 percent in patients with Gustilo type IIIB fractures. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
Collapse
Affiliation(s)
- Salma A Abdou
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - John T Stranix
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - David A Daar
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Devan D Mehta
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Toni McLaurin
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Nirmal Tejwani
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Pierre B Saadeh
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Jamie P Levine
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Philipp Leucht
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| | - Vishal D Thanik
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopaedic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, University of Virginia Health System
| |
Collapse
|
4
|
Evans SF, Chang H, Knothe Tate ML. Elucidating multiscale periosteal mechanobiology: a key to unlocking the smart properties and regenerative capacity of the periosteum? TISSUE ENGINEERING PART B-REVIEWS 2013. [PMID: 23189933 DOI: 10.1089/ten.teb.2012.0216] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The periosteum, a thin, fibrous tissue layer covering most bones, resides in a dynamic, mechanically loaded environment. The periosteum also provides a niche for mesenchymal stem cells. The mechanics of periosteum vary greatly between species and anatomical locations, indicating the specialized role of periosteum as bone's bounding membrane. Furthermore, periosteum exhibits stress-state-dependent mechanical and material properties, hallmarks of a smart material. This review discusses what is known about the multiscale mechanical and material properties of the periosteum as well as their potential effect on the mechanosensitive progenitor cells within the tissue. Furthermore, this review addresses open questions and barriers to understanding periosteum's multiscale structure-function relationships. Knowledge of the smart material properties of the periosteum will maximize the translation of periosteum and substitute periosteum to regenerative medicine, facilitate the development of biomimetic tissue-engineered periosteum for use in instances where the native periosteum is lacking or damaged, and provide inspiration for a new class of smart, advanced materials.
Collapse
Affiliation(s)
- Sarah F Evans
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | | | | |
Collapse
|
5
|
Evans SF, Chang H, Knothe Tate ML. Elucidating multiscale periosteal mechanobiology: a key to unlocking the smart properties and regenerative capacity of the periosteum? TISSUE ENGINEERING PART B-REVIEWS 2013. [PMID: 23189933 DOI: 10.1089/ten] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The periosteum, a thin, fibrous tissue layer covering most bones, resides in a dynamic, mechanically loaded environment. The periosteum also provides a niche for mesenchymal stem cells. The mechanics of periosteum vary greatly between species and anatomical locations, indicating the specialized role of periosteum as bone's bounding membrane. Furthermore, periosteum exhibits stress-state-dependent mechanical and material properties, hallmarks of a smart material. This review discusses what is known about the multiscale mechanical and material properties of the periosteum as well as their potential effect on the mechanosensitive progenitor cells within the tissue. Furthermore, this review addresses open questions and barriers to understanding periosteum's multiscale structure-function relationships. Knowledge of the smart material properties of the periosteum will maximize the translation of periosteum and substitute periosteum to regenerative medicine, facilitate the development of biomimetic tissue-engineered periosteum for use in instances where the native periosteum is lacking or damaged, and provide inspiration for a new class of smart, advanced materials.
Collapse
Affiliation(s)
- Sarah F Evans
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | | | | |
Collapse
|
6
|
Trigui M, Ayadi K, Ellouze Z, Gdoura F, Zribi M, Keskes H. Traitement des pertes de substance osseuse des membres par transport osseux segmentaire. ACTA ACUST UNITED AC 2008; 94:628-34. [DOI: 10.1016/j.rco.2008.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2008] [Indexed: 11/29/2022]
|
7
|
Kim MK, Kwon ST, Chang H, Minn KW, Cho TJ, Choi IH. Distraction histogenesis of an anastomosed artery. Injury 2008; 39:719-24. [PMID: 18336820 DOI: 10.1016/j.injury.2007.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 09/04/2007] [Accepted: 11/07/2007] [Indexed: 02/02/2023]
Abstract
This study examined the possibility of an adaptive reaction of anastomosed arteries under tension during a distraction lengthening procedure in the tibiae of rabbits. After an osteotomy at the mid tibia, the posterior tibial arteries were transected and anastomosed. Using a pair of small external fixators, the tibiae were distracted at a rate of 0.5mm/day (groups I-IV rabbits). Three weeks after 25% lengthening, the patency and histology of the arteries were examined. Angiography revealed that all of the anastomosed arteries were patent, and intimal hyperplasia was a constant finding. The mean thickness of the intima of the lengthened segment in group I was 60.4 microm, which is 5.0, 3.4 and 2.1 times higher that of the controls in groups IV (un-manipulated arteries, 12.2 microm), III (unlengthened but anastomosed arteries, 17.8 microm) and II (lengthened but untouched arteries, 28.7 microm), respectively. These results show that an anastomosed artery can maintain its patency at a certain level and speed of distraction lengthening. Therefore, it is possible that distraction lengthening and vascular anastomoses can be performed simultaneously provided there is careful monitoring of the circulation.
Collapse
Affiliation(s)
- Myung-Kuk Kim
- Department of Plastic Surgery, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
8
|
Lai D, Chen CM, Chiu FY, Chang MC, Chen TH. Reconstruction of juxta-articular huge defects of distal femur with vascularized fibular bone graft and Ilizarov's distraction osteogenesis. ACTA ACUST UNITED AC 2007; 62:166-73. [PMID: 17215750 DOI: 10.1097/ta.0b013e31802dccdb] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluate the effect of reconstructing huge defects (mean, 15.8 cm) of the distal femur with Ilizarov's distraction osteogenesis and free twin-barreled vascularized fibular bone graft (TVFG). METHODS We retrospectively reviewed a consecutive series of five patients who had cases of distal femoral fractures with huge defects and infection that were treated by the Ilizarov's distraction osteogenesis. After radical debridement, two of the five cases had free TVFG and monolocal distraction osteogenesis, and another two cases had multilocal distraction osteogenesis with knee fusion because of loss of the joint congruity. The other case with floating knee injury had bilocal distraction osteogenesis and a preserved knee joint. The mean defect of distal femur was 15.8 cm (range, 14-18 cm) in length. RESULTS The mean length of distraction osteogenesis by Ilizarov's apparatus was 8.2 cm. The mean length of TVFG was 8 cm. The average duration from application of Ilizarov's apparatus to achievement of bony union was 10.2 months (range, 8-13 months). At the end of the follow-up, ranges of motion of three knees were 0 to 45 degrees, 0 to 60 degrees, and 0 to 90 degrees. Two cases had knee arthrodesis with bony fusion because of loss of the joint congruity. There were no leg length discrepancies in all five patients. In addition, three patients had pin tract infections and one case had a 10 degree varus deformity of the femur. CONCLUSIONS Juxta-articular huge defect (>10 cm) of distal femur remains a challenge to orthopedic surgeons. Ilizarov's technique provides the capability to maintain stability, eradicate infection, restore leg length, and to perform adjuvant reconstructive procedure easily. In this study, we found that combining Ilizarov's distraction osteogenesis with TVFG results in improved patient outcome for patients with injuries such as supracondylar or intercondylar infected fractures or nonunion of distal femur with huge bone defect.
Collapse
Affiliation(s)
- Davy Lai
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, and Division of Orthopedics, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan.
| | | | | | | | | |
Collapse
|
9
|
Abstract
Vascularized bone grafting seems to be a valuable reconstructive technique for the treatment of osteomyelitis with skeletal defects greater than 6 cm in length. Fibular osteocutaneous, composite rib, and iliac osteocutaneous flaps are the most commonly used vascularized bone grafts clinically. Vascularized bone can obliterate dead space, bridge large bone defects, enhance bone healing, resist infection by ensuring blood supply, allow early rehabilitation, and ensure better clinical outcomes in the treatment of lower extremity osteomyelitis. Success rates range from 80% to 95%. Complications of surgery include anastomosis failure, donor site problems, and fracture of the grafted bone.
Collapse
Affiliation(s)
- Yuan-Kun Tu
- Orthopedic Department, E-DA Hospital, I-Shou University, No.1 E-DA Road, Yan-Chau Shiang, Kaohsiung County, Taiwan.
| | | |
Collapse
|
10
|
Watt DAL, Grotz MRW, Giannoudis PV, Kay SPJ. Lower limb salvage to allow planned trans-tibial amputation. J Plast Reconstr Aesthet Surg 2006; 59:658-61. [PMID: 16716959 DOI: 10.1016/j.bjps.2005.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 09/08/2005] [Indexed: 11/25/2022]
Abstract
Early, primary amputations are still necessary for certain patients sustaining high impact lower limb trauma. For cases with extensive proximal tibial bone loss a turn-up bone flap technique has been described to achieve a below-knee stump suitable for a prosthesis. However, in certain circumstances, for example if posterior soft tissues are injured, this type of reconstruction is not possible. This case report demonstrates that converting a severe open proximal tibial fracture to a successful below-knee amputation is also possible with acute limb shortening, flap cover and planned subsequent trans-tibial amputation.
Collapse
Affiliation(s)
- D A L Watt
- Department of Plastic, Reconstructive and Hand Surgery, St James's University Hospital, Leeds, UK.
| | | | | | | |
Collapse
|
11
|
Robert Rozbruch S, Weitzman AM, Tracey Watson J, Freudigman P, Katz HV, Ilizarov S. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma 2006; 20:197-205. [PMID: 16648701 DOI: 10.1097/00005131-200603000-00006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the potential for limb salvage using the Ilizarov method to simultaneously treat bone and soft-tissue defects of the leg without flap coverage. DESIGN Retrospective study. SETTING Level I trauma centers at 4 academic university medical centers. PATIENTS/PARTICIPANTS Twenty-five patients with bone and soft-tissue defects associated with tibial fractures and nonunions. The average soft-tissue and bone defect after debridement was 10.1 (range, 2-25) cm and 6 (range, 2-14) cm respectively. Patients were not candidates for flap coverage and the treatment was a preamputation limb salvage undertaking in all cases. INTERVENTION Ilizarov and Taylor Spatial Frames used to gradually close the bone and soft-tissue defects simultaneously by using monofocal shortening or bifocal or trifocal bone transport. MAIN OUTCOME MEASUREMENTS Bone union, soft-tissue closure, resolution or prevention of infection, restoration of leg length equality, alignment, limb salvage. RESULTS The average time of compression and distraction was 19.7 (range, 5-70) weeks, and time to soft-tissue closure was 14.7 (range, 3-41) weeks. Bony union occurred in 24 patients (96%). The average time in the frame was 43.2 (range, 10-82) weeks. Lengthening at another site was performed in 15 patients. The average amount of bone lengthening was 5.6 (range, 2-11) cm. Final leg length discrepancy (LLD) averaged 1.2 (range, 0-5) cm. Use of the trifocal approach resulted in less time in the frame for treatment of large bone and soft-tissue defects. There were no recurrences of osteomyelitis at the nonunion site. All wounds were closed. There were no amputations. All limbs were salvaged. CONCLUSIONS The Ilizarov method can be successfully used to reconstruct the leg with tibial bone loss and an accompanying soft-tissue defect. This limb salvage method can be used in patients who are not believed to be candidates for flap coverage. One also may consider using this technique to avoid the need for a flap. Gradual closure of the defect is accomplished resulting in bony union and soft-tissue closure. Lengthening can be performed at another site. A trifocal approach should be considered for large defects (>6 cm). Advances in technique and frame design should help prevent residual deformity.
Collapse
|
12
|
Chung CY, Choi IH, Yoo WJ, Cho TJ, Gong HS, Kwon ST. Distraction osteogenesis for segmental bone defect. Physeal change after acute bone shortening followed by gradual lengthening in a rabbit tibia model. Injury 2005; 36:1453-9. [PMID: 16243335 DOI: 10.1016/j.injury.2005.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 08/18/2005] [Accepted: 08/18/2005] [Indexed: 02/02/2023]
Abstract
We investigated physeal change after acute bone shortening followed by distraction osteogenesis in a rabbit tibia model. Distraction osteogenesis was performed on acutely shortened right rabbit tibia after removing a diaphyseal segment until distraction reached the length of the excised segment. Sixty animals were divided into three groups (n=20) according to the amount of shortening (20, 30, and 40% of original length) and radiographic, immunohistochemical, and histomorphometric analyses were performed to evaluate the physeal activity. The results showed no differences between groups and all animals could recover the original length without growth retardation. There was no notable venous congestion or lymphatic kinking associated with acute shortening. These results suggest that distraction osteogenesis at the primary site of shortening may have little adverse effects on the growth plate, when the shortening can provide sufficient soft tissue without vascular compromise and the amount of lengthening does not exceed that of shortening.
Collapse
Affiliation(s)
- C Y Chung
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
13
|
Rahal S, Volpi R, Vulcano L. Uso do transporte ósseo no tratamento de perda óssea segmentar extensa da tíbia: estudo experimental em cães. ARQ BRAS MED VET ZOO 2005. [DOI: 10.1590/s0102-09352005000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliou-se a técnica de transporte ósseo realizada com fixador externo de Ilizarov no tratamento de defeito ósseo segmentar extenso promovido na tíbia de sete cães. Após aplicação de montagem constituída de um semi-anel proximal, um anel médio e outro distal, ligados entre si por meio de hastes rosqueadas, foi excisado um segmento da diáfise média distal da tíbia e fíbula direitas de 30% do comprimento ósseo. A reconstrução do defeito foi realizada por transporte de um segmento ósseo obtido por osteotomia subperiosteal da parte proximal da tíbia, entre o semi-anel proximal e o anel médio. O período de latência foi de seis dias e o ritmo do transporte foi de 0,5mm a cada 12 horas. Na área de acoplamento foi aplicada compressão. O fixador permaneceu em fase neutra por 14 semanas e, após a remoção do aparelho, os animais foram observados por mais quatro semanas. O resultado funcional foi considerado excelente em um animal, bom em um, satisfatório em três e deficiente nos outros dois. O transporte ósseo permitiu a reparação de falhas ósseas segmentares extensas, porém pode apresentar dificuldades no direcionamento do segmento ósseo transportado e de sua consolidação na área de acoplagem.
Collapse
|
14
|
Sen C, Kocaoglu M, Eralp L, Gulsen M, Cinar M. Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases. J Orthop Trauma 2004; 18:150-7. [PMID: 15091269 DOI: 10.1097/00005131-200403000-00005] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and soft-tissue loss. DESIGN Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability. PATIENTS Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 x 3.5 (1 x 2-10 x 5) cm. INTERVENTIONS Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths. RESULTS Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis. CONCLUSION Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.
Collapse
Affiliation(s)
- Cengiz Sen
- Medical Faculty of Gaziosmanpasa University, Tokat, Turkey.
| | | | | | | | | |
Collapse
|
15
|
Hinsche AF, Giannoudis PV, Matthews SJE, Smith RM. Spontaneous healing of a 14 cm diaphyseal cortical defect of the tibia. Injury 2003; 34:385-8. [PMID: 12719171 DOI: 10.1016/s0020-1383(02)00026-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A F Hinsche
- Department of Trauma and Orthopaedic Surgeon, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | | | | | | |
Collapse
|
16
|
Bouletreau PJ, Warren SM, Paccione MF, Spector JA, McCarthy JG, Longaker MT. Transport distraction osteogenesis: a new method to heal adult calvarial defects. Plast Reconstr Surg 2002; 109:1074-84. [PMID: 11884839 DOI: 10.1097/00006534-200203000-00046] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Popularized by Gavril Ilizarov in the 1960s, monofocal distraction osteogenesis has become a well-established method of endogenous bone engineering. This revolutionary surgical technique has significantly augmented the available reconstructive orthopedic and craniomaxillofacial procedures. Bifocal distraction osteogenesis, or bone transportation, is a modification of monofocal distraction that involves moving a free segment of living bone to fill an intercalary bone defect. Bifocal distraction has been applied successfully to reconstruct complex mandibular and long bone defects. Because traumatic or postsurgical calvarial defects do not spontaneously heal in humans older than 18 to 24 months of age, we hypothesized that bifocal distraction osteogenesis could be applied to the skull to close critical size calvarial defects. Critical size (15 x 15 mm) calvarial defects were created in eight New Zealand White rabbits. Next, a 15-mm x 10-mm calvarial box osteotomy was created just anterior to the skull defect. This osteotomy created a free bone segment that could be transported. A custom-made transport distraction device was fixed into place and the skin incision was closed. After a 4-day latency period, the distraction device was activated (0.5 mm once daily for 30 days) in seven animals; the distraction device in one animal was not activated and served as a control. All animals underwent 30 days of consolidation and were then killed. Radiographs and computed tomographic scans were performed at the following time points: end of latency period (postoperative day 4), mid-distraction (postoperative day 19), and end of consolidation period (postoperative day 64). Gross and histologic analysis was performed to evaluate the quality of the bony regenerate. The control animal healed with a fibrous union. Complete closure of the skull defects was observed in five of seven rabbits at the end of the consolidation period. One animal was removed from the study because of an early loosening of the distraction device, and one was removed because of device failure. Of the remaining five animals that completed the distraction protocol, radiographs and computerized tomographic scans showed successful ossification in all five rabbits at the end of the consolidation period. This study suggests that transport distraction osteogenesis is a promising technique that may be applied to a variety of commonly encountered craniofacial problems such as nonhealing calvarial defects.
Collapse
Affiliation(s)
- Pierre J Bouletreau
- Department of Surgery, New York University Medical Center, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
17
|
Krikler SJ. Intramedullary nailing. Injury 2001; 32:677-8. [PMID: 11600111 DOI: 10.1016/s0020-1383(01)00169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
18
|
Tu YK, Yen CY, Yeh WL, Wang IC, Wang KC, Ueng WN. Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years' follow-up. ACTA ORTHOPAEDICA SCANDINAVICA 2001; 72:359-64. [PMID: 11580124 DOI: 10.1080/000164701753542014] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We analyzed our clinical results in 48 patients (40 men) treated during 1990-1993 with free vascularized bone-graft reconstruction for bone defects, the follow-up being an average 6 (5-8) years. The bone defects were located in the femur (10), tibia (32), humerus (2), and forearm (4). We performed 41 fibula transfers, 4 iliac transfers, and 3 rib transfers in these patients. 3 patients required early revision surgery due to venous thrombosis. The average time needed for radiographic bone union was 4.2 months. Bone transfers to the lower extremity showed significantly more hypertrophy than those in the upper extremity. The functional outcome was good in 43 patients.
Collapse
Affiliation(s)
- Y K Tu
- Orthopedic Department, Chang Gung Memorial Hospital, Taiwan.
| | | | | | | | | | | |
Collapse
|
19
|
Granhed HP, Karladani AH. Bone debridement and limb lengthening in type III open tibial shaft fractures: no infection or nonunion in 9 patients. ACTA ORTHOPAEDICA SCANDINAVICA 2001; 72:46-52. [PMID: 11327413 DOI: 10.1080/000164701753606680] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We retrospectively reviewed a consecutive series of 9 patients with tibial shaft fractures and extensive soft tissue damage, who had completed treatment by means of bone resection and distraction. 4 patients had type IIIB fractures and 5 type IIIC. The median follow-up time after bone resection was 27 (12-43) months. All patients were treated with debridement of devitalized soft tissue and resection of dead bone at the fracture site. The median bone shortening was 4 (3-9) cm. Equal limb-length was restored by proximal corticotomy and lengthening. A free vascular flap in 5 patients and a local flap in 4 patients corrected the soft tissue loss. All soft tissue transfers were successful, except in 1 case, which healed after a new free flap was made. The median union time of the fracture was 8 (4.5-28) months from the injury and 7 (3-10) months from the time of bone resection. There were no deep infections or nonunions and no secondary amputations. This series shows that bone debridement and limb lengthening, with a multidisciplinary approach, is often successful in salvaging limbs at high risk of amputation.
Collapse
Affiliation(s)
- H P Granhed
- Department of Orthopedics, Sahlgrenska University Hospital/Göteborg University, Sweden.
| | | |
Collapse
|