Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved

Table 4 Largest clinical studies published in 2015-2019 and their outcomes with distraction osteogenesis techniques

Ref.	Number of patients	Fixation type / bone union rate	Problems requiring reoperations after frame removal or failures
Defects of tibia
Kinik et al[14], 2019, Turkey	30	Ilizarov/96.66%	1 nonunion, 1 refracture of the regenerate, 1 late deformity of the regenerate
Fahad et al[15], 2019, Pakistan	51	Ilizarov/96%	2 nonunions (1 amputation due to sepsis), 2 reinfections eradicated during main treatment
Thakeb et al[16], 2019, Egypt	50	Ilizarov/100%
Catagni et al[17], 2019, Italy	86	Ilizarov/100%	4 refractures
Wu et al[18], 2018, China	40	Ilizarov/100%
Yilihamu et al[19], 2017, China	129	Ilizarov + Orthofix/100%
McNally et al[20], 2017, United Kingdom	79	Ilizarov/86.1%	2 refractures, recurrence of infection, 6 after-frame reoperations
El-Alfy et al[21], 2017, Egypt	28	Ilizarov/100%
Meleppuram et al[22], 2016, India	42	Ilizarov/100%
Abuomira et al[23], 2016, Italy	55	Ilizarov + Taylor spatial frame/89%	1 osteitis, 2 bending of regenerate, 2 refractures of the docking site, 1 nonunion
Rohilla et al[24], 2016, India	70	Ilizarov vs rail fixator/77% vs 80% of primary union	The rail fixator was converted to a ring fixator in two patients, 2 after-frame refractures
Sadek et al[25], 2016, Egypt	30	Ilizarov vs two stage internal osteosynthesis	1 nonunion in internal group
Bernstein et al[26], 2015, United States	30	Ilizarov/77%	-
Peng et al[27], 2015, China	58	Ilizarov/100%	4 equinovarus deformities, 1 infection recurrence at the docking site
Defects due to acute fractures
van Niekerk et al[28], 2017, South Africa	24	Ilizarov/91.7%	2 amputations, 1 persistent deep infection in a HIV-positive patient, mangled extremity
Salih et al[29], 2018, United Kingdom	31	Ilizarov/96%	4 after-frame refractures, 2 regenerate deformities after frame, 1 stiff non-union
Fuermitz et al[30], 2016, Germany	25	Ilizarov or hybrid/92%	2 amputations due to comorbidities
Azzam et al[31], 2016, Еgypt	30	Ilizarov/93.3%	1 post-frame fracture
Thakeb et al[32], 2016, Egypt	161	Ilizarov	1 failure
Ajmera et al[33], 2015, India	30	Monolateral/93%	2 nonunions
Large-scale defects requiring tibilization of the fibula
Meselhy et al[34], 2018, Egypt	141	Ilizarov/100%
Zaman et al[35], 2017, Pakistan	121	Ilizarov/100%	1 supracondylar femoral fracture while removing frame
Defect of femur
Bakhsh et al[36], 2019, Pakistan	50	Ilizarov/98%	2 nonunions, 1 refracture
Zhang et al[37], 2017, China	41	Monolateral/98%	1 refracture, 5 cases of docking site nonunion
Mudiganty et al[38], 2017, India	22	Monolateral rail/97.5%
Agrawal et al[39], 2016, India	30	Monorail/100%	5 delayed union with autograft
Defects of femur and tibia
Ariyawatkul et al[40], 2019, Thailand	171	Ilizarov/94%	1 nonunion
Lowenberg et al[41], 2015, United States	127	Ilizatov/96%	3 amputations due to comorbidities
Yin et al[42], 2015, China	110	Ilizarov for tibia, monolateral for femur/100%	2 after-frame refractures
Tumor- resection defects
Eralp et al[43], 2016 (Turkey, United States, Egypt)	20	Various types of external fixators/100%	1 knee arthrodesis
Wang et al[44], 2019, China	101	Monolateral/90%	1 amputation at long-term due to cancer relapse

¹Smaller groups for rare conditions treated with the Ilizarov method (severely comminuted fractures, pan tibial defects, large periarticular defects). HIV: Human immunodeficiency virus.