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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Ibrahim MAA, Alhomayani KM, Gaber U, Bukhary HA, Nematallah SA, Elgahel MM. Radiographic and functional results of Ilizarov fixation in the management of nonunion of tibia and femur fractures: a retrospective case series. Ann Saudi Med 2024; 44:146-152. [PMID: 38853476 PMCID: PMC11268481 DOI: 10.5144/0256-4947.2024.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/13/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Femoral and tibial fractures may result in delayed union and nonunion, posing significant challenges in orthopedic practice. The Ilizarov technique has emerged as a promising solution for managing these complex cases. OBJECTIVES Evaluate the radiographic and functional results of Ilizarov fixation in the treatment of nonunion of tibia and femur fractures. DESIGN Retrospective. SETTINGS Hospitals affiliated with a university hospital. PATIENTS AND METHODS Patient demographics, fracture characteristics, and treatment details were analyzed for the period from October 2015 to September 2022 in patients who were treated for nonunion of the tibia and femur using the Ilizarov fixator. Clinical and radiological assessments were performed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The study focused on assessing the average duration for union and frame removal, bone results, successful union rates, and functional results using the ASAMI criteria, obtaining data from the existing medical records, spanning various medical facilities treating nonunion fractures. SAMPLE SIZE 126 patients. RESULTS The average duration for union and frame removal was 8 months, with excellent bone results observed in 60.32% of cases. Out of 126 patients, 118 achieved successful union, while there were 2 failure cases necessitating amputation (1.52%). Functional results revealed excellent outcomes in 39.68% of cases. Complications included pin tract infections, ankle and knee stiffness, and limb shortening. External fixation duration and infection eradication were consistent with previous research, emphasizing the technique's effectiveness. CONCLUSIONS The Ilizarov technique proved highly effective in managing nonunion tibia and femur fractures, offering favorable outcomes in terms of union, infection control, pain relief, and functional recovery. While excellent bone outcomes do not guarantee optimal function, this method remains a reliable approach for complex cases. LIMITATIONS Potential biases inherent in retrospective analyses and the need for further randomized controlled trials to comprehensively compare treatment modalities.
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Affiliation(s)
| | - Khalid M. Alhomayani
- From the Orthopaedic Division, Department of Surgery, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Usama Gaber
- From the Department of Orthopedics, Al-Azhar University, Cairo, Egypt
| | - Hashem A. Bukhary
- From the Orthopaedic Division, Department of Surgery, Faculty of Medicine, Taif University, Taif, Saudi Arabia
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Reddy VN, Reddy R, Safiullah M. A Case of "Nonunion Distal Tibia and Fibula Malleoli Fracture with posterior Malleoli Fracture" Treated with Ilizarov: A Case Report. J Orthop Case Rep 2024; 14:121-124. [PMID: 38420223 PMCID: PMC10898707 DOI: 10.13107/jocr.2024.v14.i02.4240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/30/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Orthopedic surgeons have long acknowledged the difficulty of treating distal tibia and fibula fractures with posterior malleoli fractures in individuals with medical comorbidities due to a lack of inadequate blood supply. Aged Type 2 diabetic individuals, with distal tibia and fibula fracture with posterior malleoli fracture, are more prone to complications such as non-union, wound infection, and delayed bone healing. It is debatable whether surgical or non-invasive treatment is preferable for diabetic complex fractures. Case Report A 62-year-old male suffered a right distal tibia and fibula fracture with posterior malleoli fracture following an incidental fall followed by a hit over the iron rod. The patient was treated conservatively with POP for 6 weeks due to the patient's refusal of surgical management. Radiography after 6 weeks revealed features of non-union. Conclusion The Ilizarov external fixation with bone graft was planned later to treat the non-union distal tibia and fibula fracture with posterior malleoli fracture. About 18 months after the Ilizarov fixation radiography reviewed the features of the union and clinically also patient improved.
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Affiliation(s)
| | - Rajlaxmi Reddy
- Department of Orthopaedics, Sree Balaji Medical College, Chennai, Tamil Nadu, India
| | - Mohamed Safiullah
- Department of Orthopaedics, Sree Balaji Medical College, Chennai, Tamil Nadu, India
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Zhang H, Fu J, Jie S, Wang X, Wang S, Wu H, Hu Y, Huang C. Induced membrane technique versus one-stage autografting in management of atrophic nonunion of long bone in the lower limb: clinical and health burden outcomes. J Orthop Surg Res 2023; 18:853. [PMID: 37946277 PMCID: PMC10636875 DOI: 10.1186/s13018-023-04296-1] [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: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones. METHODS From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year. RESULTS In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane-Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770). CONCLUSION The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making.
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Affiliation(s)
- Hu Zhang
- Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Jingshu Fu
- Banan Hospital of Chongqing Medical University, Banan District, Longzhouwan Street No. 659, Chongqing City, 400038, People's Republic of China
| | - Shen Jie
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Xiaohua Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Shulin Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Hongri Wu
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China.
- Department of Orthopedics, Navy 905th Hospital, Naval Medical University, Shanghai, People's Republic of China.
| | - Yongjun Hu
- Banan Hospital of Chongqing Medical University, Banan District, Longzhouwan Street No. 659, Chongqing City, 400038, People's Republic of China.
| | - Chunji Huang
- Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China.
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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: 1] [Impact Index Per Article: 0.5] [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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Liu K, Zhang H, Maimaiti X, Yusufu A. Bifocal versus trifocal bone transport for the management of tibial bone defects caused by fracture-related infection: a meta-analysis. J Orthop Surg Res 2023; 18:140. [PMID: 36841800 PMCID: PMC9968413 DOI: 10.1186/s13018-023-03636-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to compare the efficacy and outcomes of bifocal bone transport (BFT) and trifocal bone transport (TFT) for the treatment of tibial bone defects caused by fracture-related infection (FRI). METHODS The literature searches of Cochrane Library, Embase, Google Scholar databases, PubMed/Medline, and Web of Science for literature published up to September 20, 2022, were performed. The quality of the included studies was evaluated according to the MINORS scale. Patients were divided into the BFT group and the TFT group, depending on the site of the osteotomy. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), bone and functional results, complications, and autologous bone grafting (ABG) were extracted and analyzed using the Review Manager software (version 5.3). RESULTS Five studies included 484 patients with tibial bone defects treated by bone transport investigated in this meta-analysis, with a mean bone defect of 9.3 cm. There were statistical differences in DS (MD = - 2.38, 95% CI - 3.45 to - 1.32, P < 0.0001), EFT (MD = 103.44, 95% CI 60.11 to 146.77, P < 0.00001), and EFI (MD = 26.02, 95% CI 14.38 to 37.65, P < 0.00001) between BFT group and TFT group. There was no statistical difference in bone results (RR = 0.98, 95% CI 0.91 to 1.06, P = 0.67), functional results (RR = 0.94, 95% CI 0.82 to 1.07, P = 0.37), complications (OR = 1.57, 95% CI 0.59 to 4.14, P = 0.36), and ABG (RR = 1.2, 95% CI 0.78 to 1.84, P = 0.42) between two groups. CONCLUSIONS TFT was a feasible and practical method in the treatment of massive tibial bone defects caused by FRI to receive shorter EFT and satisfactory bone and functional results.
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Affiliation(s)
- Kai Liu
- grid.412631.3Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Hongyan Zhang
- grid.412631.3The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Xiayimaierdan Maimaiti
- grid.412631.3Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Qian H, Yao Q, Pi L, Ao J, Lei P, Hu Y. Current Advances and Applications of Tantalum Element in Infected Bone Defects. ACS Biomater Sci Eng 2023; 9:1-19. [PMID: 36563349 DOI: 10.1021/acsbiomaterials.2c00884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Infected bone defects (IBDs) cause significant economic and psychological burdens, posing a huge challenge to clinical orthopedic surgeons. Traditional approaches for managing IBDs possess inevitable shortcomings; therefore, it is necessary to develop new functionalized scaffolds. Tantalum (Ta) has been widely used in load-bearing orthopedic implants due to its good biocompatibility and corrosion resistance. However, undecorated Ta could only structurally repair common bone defects, which failed to meet the clinical needs of bacteriostasis for IBDs. Researchers have made great efforts to functionalize Ta scaffolds to enhance their antibacterial activity through various methods, including surface coating, alloying, and micro- and nanostructure modifications. Additionally, several studies have successfully utilized Ta to modify orthopedic scaffolds for enhanced antibacterial function. These studies remarkably extended the application range of Ta. Therefore, this review systematically outlines the advances in the fundamental and clinical application of Ta in the treatment of IBDs, focusing on the antibacterial properties of Ta, its functionalization for bacteriostasis, and its applications in the modification of orthopedic scaffolds. This study provides researchers with an overview of the application of Ta in the treatment of IBDs.
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Affiliation(s)
- Hu Qian
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Qingshuang Yao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Lanping Pi
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Pengfei Lei
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310030, China
| | - Yihe Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310030, China
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Abula A, Cheng E, Abulaiti A, Liu K, Liu Y, Ren P. Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport. BMC Musculoskelet Disord 2022; 23:900. [PMID: 36209097 PMCID: PMC9548124 DOI: 10.1186/s12891-022-05852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to investigate the risk factors of transport gap bending deformity (TGBD) in the treatment of critical-size bone defect (CSBD) after the removal of the external fixator. Methods From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using a unilateral external fixator in our medical institution. TGBD was defined as the bone callus in the distraction area with a deviation to the force line of the femur (> 10°) or tibia (> 12°) after removal of the external fixator. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson’s Chi-square test was analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD. Results A total of 178 patients were enrolled in the study, with a mean follow-up time of 28.6 ± 3.82 months. The positive result of the bacteria isolated test was observed in 144 cases (80.9%). The rate of excellent and good in the bone outcomes (excellent/good/fair/poor/failure, 41/108/15/14/0) was 83.7%, and 92.3% in the functional results (excellent/good/fair/poor/failure, 50/98/16/14/0) according to the ASAMI criteria. TGBD after removal of external fixator occurred in twenty-two patients (12.3%), including 6 tibias, and 16 femurs. Age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, osteoporosis, glucocorticoid intake, duration of infection > 24 months, EFT > 9 months, EFI > 1.8 month/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis (P < 0.05). The incidence more than 50% was found in patients with femoral defect (76.1%), osteoporosis (72.7%), BMI > 25 kg/m2 (69.0%), diabetes (59.5%), glucocorticoid intake (54.7%). In the multivariate logistic regression analyses, the following factors were associated independently with TGBD, including age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, and osteoporosis. Conclusions Bone transport using a unilateral external fixator was a safe and practical method in the treatment of CSBD caused by infection. The top five risk factors of TGBD included femoral defect, BMI > 25 kg/m2, duration of bone infection > 24 months, age > 45 years, and diabetes. Age > 45 years, BMI > 25 kg/m2, femoral defect, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.
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Affiliation(s)
- Abulaiti Abula
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Erlin Cheng
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Alimujiang Abulaiti
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Wang G, Alagboso FI, Walter N, Baertl S, Brochhausen C, Docheva D, Rupp M, Alt V. Bone regeneration after marginal bone resection in two-stage treatment of chronic long bone infection - a combined histopathological and clinical pilot study. Injury 2022; 53:3446-3457. [PMID: 35851476 DOI: 10.1016/j.injury.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In chronic bone infection, marginal bone resection avoids large and difficult to reconstruct bone defects. However, there is still a lack of knowledge on bone regeneration during chronic bone infection and bone healing capability after marginal bone resection. Therefore, the purpose of this study was to investigate the clinical and histopathological outcomes after marginal bone resection in chronic long bone infection. We hypothesized that there is a regenerative bone healing potential after marginal bone resection that results in an acceptable clinical outcome and improved pathohistological bone healing parameters during treatment. MATERIALS AND METHODS Nine patients were treated for chronic bone infections in a two-stage manner with marginal bone resection of the infected area and the placement of an antibiotic-loaded polymethyl methacrylate (PMMA) spacer at stage one followed by bone reconstruction at stage two combined with systemic antibiotic therapy. Comparable bone samples were harvested at the border region between vital and necrotic bone area during stage one and the identical location during stage two. Control bone samples were harvested from five healthy patients without bone infection. Clinical outcome in terms of infection eradication and bone consolidation were assessed. The phenotypic changes of osteocyte and morphological changes of lacunar-canalicular network were investigated by histological and immunohistochemical staining between the two observation periods. Furthermore, expression levels of major bone formation and resorption markers were investigated by immunohistochemical and tartrate-resistant acid phosphatase (TRAP) staining. RESULTS The clinical results with a follow-up of 12.9 months showed that eight of nine patients (88.9%) achieved bone consolidation after a planned two-stage procedure of marginal resection of necrotic bone and consecutive reconstruction. In four of the nine patients (44.4%), additional marginal debridements after stage two had to be performed. After marginal resection at stage one, the improved bone formation ability at stage two was demonstrated by significantly lower percentage of empty lacunae, significantly more mature osteocytes and higher BMP-2 positive cell density, whereas decreased resorption was indicated by significantly lower osteoclast density and RANKL/OPG ratio. In patients requiring additional debridement compared to patients without additional debridements, a significantly higher percentage of empty lacunae was found at stage one. CONCLUSION Marginal bone resection combined with local and systemic antibiotic therapy is a feasible treatment option to avoid large bone defects as bone from the marginal resection area seems to have good regenerative potential. Despite a high revision rate of 44.4%, this technique avoids large bone resection and revisions can be done by further marginal debridements.
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Affiliation(s)
- Gongteng Wang
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany
| | - Francisca I Alagboso
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany
| | - Nike Walter
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany; Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany
| | - Susanne Baertl
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany; Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany
| | | | - Denitsa Docheva
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany; Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wuerzburg, Germany
| | - Markus Rupp
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany; Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany.
| | - Volker Alt
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany; Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg 93053, Germany.
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Nonunion of the femoral shaft associated with limb shortening treated with a combined technique of external fixation over an intramedullary nail versus the Ilizarov method. Arch Orthop Trauma Surg 2022; 142:2185-2192. [PMID: 33651147 DOI: 10.1007/s00402-021-03804-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Post-traumatic nonunion of the femur remains a challenging problem even for experienced orthopedic surgeons. The main question is the choice of the optimal surgical tool. MATERIALS AND METHODS Management of 20 patients with nonunion of the femoral diaphysis associated with anatomical shortening was retrospectively analyzed. Group A (n = 14) was treated with a hybrid technique that combined the Ilizarov external fixation and intramedullary nailing. The Ilizarov bone transport was used in group B (n = 6). Patients of both groups had aseptic post-traumatic nonunion. Mean shortening was 4.5 ± 0.4 cm in group A and 4.8 ± 1.0 cm in group B (p = 0.459959). RESULTS Union was achieved in 85.7% of group A and 100% of group B patients. External fixation was repeated in two cases of group A and achieved consolidation. Deep infection developed in one case of group A after 15 months post-frame with the nail in. It was resolved by nail removal, surgical debridement and external fixation. Limb shortening was fully eliminated in eleven cases of group A and four patients of group B. The average duration of distraction was 35.3 ± 1.7 days in group A and 47.8 ± 9.3 days in group B. The total duration of external fixation was 49.1 ± 3.5 and 177.2 ± 21.9 days with an external fixation index of 13.1 ± 1.2 and 52.4 ± 6.4 days/cm, respectively. Distraction regenerate consolidated in all the cases. CONCLUSION Hybrid technique provides bone union with compensation of limb shortening and reduces the treatment period as compared with the Ilizarov method used alone. However, deep infection may happen.
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Daskalakis E, Huang B, Vyas C, Acar AA, Liu F, Fallah A, Cooper G, Weightman A, Blunn G, Koç B, Bartolo P. Bone Bricks: The Effect of Architecture and Material Composition on the Mechanical and Biological Performance of Bone Scaffolds. ACS OMEGA 2022; 7:7515-7530. [PMID: 35284712 PMCID: PMC8908495 DOI: 10.1021/acsomega.1c05437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/14/2022] [Indexed: 05/14/2023]
Abstract
Large bone loss injuries require high-performance scaffolds with an architecture and material composition resembling native bone. However, most bone scaffold studies focus on three-dimensional (3D) structures with simple rectangular or circular geometries and uniform pores, not able to recapitulate the geometric characteristics of the native tissue. This paper addresses this limitation by proposing novel anatomically designed scaffolds (bone bricks) with nonuniform pore dimensions (pore size gradients) designed based on new lay-dawn pattern strategies. The gradient design allows one to tailor the properties of the bricks and together with the incorporation of ceramic materials allows one to obtain structures with high mechanical properties (higher than reported in the literature for the same material composition) and improved biological characteristics.
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Affiliation(s)
- Evangelos Daskalakis
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
| | - Boyang Huang
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
| | - Cian Vyas
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
| | - Anil A. Acar
- Integrated
Manufacturing Technologies Research and Application Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- SUNUM Nanotechnology
Research Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- Faculty
of Engineering and Natural Sciences, Sabanci
University, Tuzla 34956, Istanbul, Turkey
| | - Fengyuan Liu
- Department of
Mechanical Engineering, School of Civil, Aerospace and Mechanical
Engineering, Faculty of Engineering, University
of Bristol, Bristol BS8 1TR, U.K.
| | - Ali Fallah
- Integrated
Manufacturing Technologies Research and Application Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- SUNUM Nanotechnology
Research Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- Faculty
of Engineering and Natural Sciences, Sabanci
University, Tuzla 34956, Istanbul, Turkey
| | - Glen Cooper
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
| | - Andrew Weightman
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, PortsmouthPO1 2DT, U.K.
| | - Bahattin Koç
- Integrated
Manufacturing Technologies Research and Application Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- SUNUM Nanotechnology
Research Center, Sabanci University, Tuzla 34956, Istanbul, Turkey
- Faculty
of Engineering and Natural Sciences, Sabanci
University, Tuzla 34956, Istanbul, Turkey
| | - Paulo Bartolo
- School of Mechanical,
Aerospace and Civil Engineering, University
of Manchester, ManchesterM13 9PL, U.K.
- Singapore
Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore
- ,
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Janssen SJ, Kloen P. Supercutaneous locking compression plate in the treatment of infected non-union and open fracture of the leg. Arch Orthop Trauma Surg 2022; 142:3201-3211. [PMID: 34350497 PMCID: PMC9522724 DOI: 10.1007/s00402-021-04104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Salvage of infected tibia and fibula non-union and severe open fractures is challenging and often requires staged treatment. We describe all cases that underwent supercutaneous plating of the leg as external fixation technique and assessed union rate, time to union, rate of infection clearance, and patient-reported outcome measures. METHODS This is a retrospective cohort study from a single level 1 trauma center. We included 19 patients that underwent supercutaneous plating-locking compression plate applied as external fixator-of the leg. Indications were: infected non-union of a pilon, cruris, or ankle fracture (n = 13); post-traumatic fistula draining osteomyelitis of the tibia (n = 3); infected mal-reduced subacute cruris fracture (n = 1); acute open pilon fracture (n = 1); and acute open cruris fracture (n = 1). Outcome measures were: union, time to union, infection clearance, the 36-item Short Form (SF-36) physical component summary scale (PCS) and mental component summary scale (MCS), and NRS pain scores. RESULTS Union was achieved in 88% of the patients after a median of 279 days [interquartile range (IQR) 154-440]. Infection clearance was achieved in 94% of the patients. The PCS (median 51, IQR 46-56, p = 0.903) and MCS (median 57, IQR 50-60, p = 0.241) do not differ from normative population values. NRS Pain score at rest was 0 on average (IQR 0-1), 2 on average when walking (IQR 0-4), and 1 on average when climbing stairs (IQR 0-2). CONCLUSION Supercutaneous plating is a simple and reliable technical trick to bridge and stabilize a nonunion or fracture site while clearing an infection and have soft-tissues heal before subsequent definitive (internal)fixation and/or cancellous bone grafting. Reasonable union and infection clearance rates are achieved, and good functional outcome can generally be expected. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Stein J. Janssen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Peter Kloen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Auf der Strasse W, Campos DP, Mendonça CJA, Soni JF, Mendes J, Nohama P. Evaluation of Tibia Bone Healing by Infrared Thermography: A Case Study. J Multidiscip Healthc 2021; 14:3161-3175. [PMID: 34803384 PMCID: PMC8598209 DOI: 10.2147/jmdh.s330094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background Thermal imaging has been used as a clinical follow-up technique in several medical specialties. Purpose The aim of this study was to investigate the feasibility of using medical thermography in the diagnosis and follow-up assessment of a severe orthopedic trauma that requires the use of an external circular fixator. Patients and Methods Twenty clinical follow-ups of thermal imaging correlated with X-ray images were performed in a male volunteer, diagnosed with bone nonunion, during 11 months of treatment, in the hospital trauma and reconstruction department. Data were acquired in the regions of interest of the proximal tibia, diaphysis and distal, with a Flir T530 medical grade infrared camera from Flir Systems®, and the data processed by the Matlab® 2019 custom made software. Results Statistical analysis was performed by Wilcoxon signed-rank test. The results showed a median temperature of 22.2°C, and thus some periods of interruption in the healing process between the third and twentieth clinical follow-up, and a significant increase of the temperature to 34.6°C synchronous with a diagnosis of bone infection by the eleventh clinical follow-up. The thermal images acquired during the 20 clinical follow-ups allow a correlation with the data from the X-ray exams and also with the contralateral limb of the evaluated patient, showing thermal alterations greater than 0.3°C, which are significant of physiological abnormality. Conclusion The thermography exam can be a useful tool for applying on the follow-up of patients after trauma or bone fracture. The results showed important physiological data related to the vascularization necessary for bone repairing, being therefore a good indicator of the healing process. In addition, as infrared thermography does not use ionizing radiation, it can be used countlessly, in complement to the traditional X-ray exams that focus on anatomical data analysis.
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Affiliation(s)
| | | | | | | | - Joaquim Mendes
- INEGI, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Percy Nohama
- Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil.,Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
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Giordano V, Souza FS, Belangero WD, Pires RE. Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection-The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1220. [PMID: 34833438 PMCID: PMC8624929 DOI: 10.3390/medicina57111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Open traumatic lesion of the popliteal artery is relatively rare. Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss. Severe local infection is critical in the presence of major soft tissue trauma or open fractures. We report the case of a young female who suffered a traumatic transection of the popliteal artery associated with an open fracture of the distal tibia and fibula managed by direct vessel reconstruction with an end-to-end repair and skeletal stabilization initially with half-pin external fixation, then replaced by an Ilizarov circular frame. The patient had a very satisfactory outcome, but the fracture healed malunited, later corrected by open reduction and internal fixation with lag-screwing and a neutralization plate.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-060, Brazil;
| | - Felipe Serrão Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-060, Brazil;
| | - William Dias Belangero
- Departamento de Ortopedia, Universidade Estadual de Campinas, Campinas 13083-887, Brazil;
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
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Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100 th birthday of G. A. Ilizarov). World J Orthop 2021; 12:515-533. [PMID: 34485099 PMCID: PMC8384611 DOI: 10.5312/wjo.v12.i8.515] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed "limb lengthening and reconstruction surgery". Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal's rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
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Affiliation(s)
- Tatiana A Malkova
- Department of Medical Information and Analysis, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan 640014, Russia
| | - Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
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Chen ZY, Gao S, Zhang YW, Zhou RB, Zhou F. Antibacterial biomaterials in bone tissue engineering. J Mater Chem B 2021; 9:2594-2612. [PMID: 33666632 DOI: 10.1039/d0tb02983a] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bone infection is a devastating disease characterized by recurrence, drug-resistance, and high morbidity, that has prompted clinicians and scientists to develop novel approaches to combat it. Currently, although numerous biomaterials that possess excellent biocompatibility, biodegradability, porosity, and mechanical strength have been developed, their lack of effective antibacterial ability substantially limits bone-defect treatment efficacy. There is, accordingly, a pressing need to design antibacterial biomaterials for effective bone-infection prevention and treatment. This review focuses on antibacterial biomaterials and strategies; it presents recently reported biomaterials, including antibacterial implants, antibacterial scaffolds, antibacterial hydrogels, and antibacterial bone cement types, and aims to provide an overview of these antibacterial materials for application in biomedicine. The antibacterial mechanisms of these materials are discussed as well.
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Affiliation(s)
- Zheng-Yang Chen
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China.
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